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Delirium in elderly people: a study of a psychiatric liaison service in north India

Published online by Cambridge University Press:  28 September 2011

Sandeep Grover ,
Natasha Kate ,
Munish Agarwal ,
Surendra Kumar Mattoo ,
Ajit Avasthi ,
Savita Malhotra ,
Parmanand Kulhara ,
Subho Chakrabarti  and
Debasish Basu
Sandeep Grover*
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Natasha Kate
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Munish Agarwal
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Surendra Kumar Mattoo
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Ajit Avasthi
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Savita Malhotra
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Parmanand Kulhara
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Subho Chakrabarti
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Debasish Basu
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
*
Correspondence should be addressed to: Dr Sandeep Grover, Assistant Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Phone: +91-172-2756807; Fax: +91-172-2744401; 2745078. Email: drsandeepg2002@yahoo.com.
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Abstract

Background: Very few studies from India have studied the phenomenology of delirium. The aim of the present study was to study the phenomenology as measured using the Delirium Rating Scale-Revised-98 (DRS-R98), the associated etiologies and the outcome of delirium among the elderly participants seen by the consultation-liaison psychiatric service in India. In addition, an attempt was made to study the factor structure of symptoms using principal components analysis.

Methods: The case notes of 109 elderly patients referred to psychiatry liaison services were reviewed.

Results: The mean age of the sample was 73.35 years (SD: 7.44; range 65–95 years) and two-thirds of the sample had hospital emergent delirium. The mean DRS-R98 severity score was 18.77 and the DRS-R98 total score was 24.81. In 15 patients the DRS-R98 scores were in the subsyndromal range. Among the various symptoms present, most patients had sleep-wake cycle disturbance, disturbance in orientation, attention and short-term memory impairments, fluctuation of symptoms, temporal onset of symptoms and a physical disorder. Principal components analysis identified three factors which explained 43.5% of variance of symptomatology and it yielded a three-factor structure. Endocrine/metabolic disturbances were the commonest associated etiological category with delirium. The mean hospital stay after being referred to psychiatry referral services was 8.89 days, after which delirium improved in 58.7% of cases. The mortality rate during the inpatient stay was 16.5%.

Conclusions: Results suggest that the symptoms of delirium as assessed by DRS-R98 separate out into a three-factor structure. Delirium is commonly associated with metabolic endocrine disturbances and about one-sixth of the patients die during the short inpatient stay.

Keywords

consultation-liaisondeliriumphenomenologyetiologyoutcomefactor analysis
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 1 , January 2012 , pp. 117 - 127
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Camus, V., Burtin, B., Simeone, I., Schwed, P., Gonthier, R. and Dubos, G. (2000). Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium. International Journal of Geriatric Psychiatry, 2000, 15, 313–316.3.0.CO;2-M>CrossRefGoogle Scholar
Chrispal, A., Mathews, K. P. and Surekha, V. (2010). The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India. Journal of Association of Physicians in India, 58, 15–19.Google Scholar
Cole, M. G., Ciampi, A., Belzile, E. and Zhong, L. (2009). Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age and Ageing, 38, 19–26.CrossRefGoogle ScholarPubMed
de Jonghe, J. F. M., Kalisvaart, K. J., Timmers, J. F. M., Kat, M. G. and Jackson, J. C. (2005). Delirium-O-Meter: a nurses’ rating scale for monitoring delirium severity in geriatric patients. International Journal of Geriatric Psychiatry, 20, 1158–1166.CrossRefGoogle ScholarPubMed
de Rooij, S. E., Schuurmans, M. J., van der Mast, R. C. and Levi, M. (2007). Clinical subtypes of delirium and their relevance for daily clinical practice: a systematic review. International Journal of Geriatric Psychiatry, 20, 609–615.CrossRefGoogle Scholar
Fann, J. R., Alfano, C. M., Burington, B. E., Roth-Roemer, S., Katon, W. J. and Syrjala, K. L. (2005). Clinical presentation of delirium in patients undergoing hematopoietic stem cell transplantation. Cancer, 103, 810–820.CrossRefGoogle ScholarPubMed
Fong, T. G., Tulebaev, S. R. and Inouye, S. K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Nature Review of Neurology, 5, 210–220.CrossRefGoogle ScholarPubMed
Franco, J. G., Trzepacz, P. T., Mejıa, M. A. and Ochoa, S. B. (2009). Factor analysis of the Colombian translation of the Delirium Rating Scale (DRS), Revised–98. Psychosomatics, 50, 255–262.CrossRefGoogle ScholarPubMed
Grassi, L. et al. (2001). Assessing delirium in cancer patients: the Italian versions of the Delirium Rating Scale and the Memorial Delirium Assessment Scale. Journal of Pain Symptom Management, 21, 59–68.CrossRefGoogle Scholar
Grover, S. et al. (2009). Prevalence and clinical profile of delirium: a study from a tertiary care hospital in north India. General Hospital Psychiatry, 31, 25–29.CrossRefGoogle ScholarPubMed
Grover, S., Chakrabarti, S., Shah, R. and Kumar, V. (2011a). A factor analytic study of Delirium Rating Scale-Revised 98 in untreated delirium patients. Journal of Psychosomatic Research, 70, 473–478.CrossRefGoogle Scholar
Grover, S., Mattoo, S. K. and Gupta, N. (2011b). Usefulness of atypical antipsychotics and choline esterase inhibitors in delirium: a review. Pharmacopsychiatry, 44, 43–54.CrossRefGoogle ScholarPubMed
Gupta, N., de Jonghe, J., Schieveld, J., Leonard, M. and Meagher, D. (2008). Delirium phenomenology: what can we learn from the symptoms of delirium? Journal of Psychosomatic Research, 65, 215–222.CrossRefGoogle ScholarPubMed
Ingle, G. K. and Nath, A. (2008). Geriatric health in India: concerns and solutions. Indian Journal of Community Medicine, 33, 214–218.Google ScholarPubMed
Inouye, S. K. (1999). Predisposing and precipitating factors for delirium in hospitalized older patients. Dementia and Geriatric and Cognitive Disorders, 10, 393–400.CrossRefGoogle ScholarPubMed
Inouye, S. K. and Charpentier, P. A. (1996). Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA, 275, 852–857.CrossRefGoogle ScholarPubMed
Inouye, S. K., Rushing, J. T., Foreman, M. D., Palmer, R. M. and Pompei, P. (1998). Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Journal of General Internal Medicine, 13, 234–242.CrossRefGoogle ScholarPubMed
Khurana, P., Sharma, P. S. V. N. and Avasthi, A. (2002a). Prevalence of delirium in geriatric hospitalized general medical population. Indian Journal of Psychiatry, 44, 41–46.Google ScholarPubMed
Khurana, P., Sharma, P. S. V. N. and Avasthi, A. (2002b). Risk factors in delirious geriatric general medical inpatients. Indian Journal of Psychiatry, 44, 266–272.Google ScholarPubMed
Mattoo, S. K., Grover, S. and Gupta, N. (2010). Delirium in general practice. Indian Journal of Medical Research, 131, 387–398.Google ScholarPubMed
Mattoo, S. K., Grover, S., Chakravarty, K., Trzepacz, P., Meagher, D. J. and Gupta, N. (in press). Symptom profile and etiology of delirium in a referral population in northern India: factor analysis of the DRS-R98. Journal of Neuropsychiatry and Clinical Neurosciences.Google Scholar
McCusker, J., Cole, M., Abrahamowicz, M., Primeau, F. and Belzile, E. (2002). Delirium predicts 12-month mortality. Archives of Internal Medicine, 162, 457–463.CrossRefGoogle ScholarPubMed
Meagher, D. J. et al. (2007). Phenomenology of delirium: assessment of 100 adult cases using standardised measures. British Journal of Psychiatry, 190, 135–141.CrossRefGoogle ScholarPubMed
Saravay, S. M. et al. (2004). How do delirium and dementia increase length of stay of elderly general medical inpatients? Psychosomatics, 45, 235–242.CrossRefGoogle ScholarPubMed
Saxena, S. and Lawley, D. (2009). Delirium in the elderly: a clinical review. Postgraduate Medicine Journal, 85, 405–413.CrossRefGoogle ScholarPubMed
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical inpatients: a systematic literature review. Age and Ageing, 35, 350–364.CrossRefGoogle ScholarPubMed
Trzepacz, P. T. and Dew, M. A. (1995). Further analyses of the Delirium Rating Scale. General Hospital Psychiatry, 17, 75–79.CrossRefGoogle ScholarPubMed
Trzepacz, P. T., Mulsant, B. H., Dew, M. A., Pasternak, R., Sweet, R. A. and Zubenko, G. S. (1998). Is delirium different when it occurs in dementia? A study using the Delirium Rating Scale. Journal of Neuropsychiatry and Clinical Neurosciences, 10, 199–204.CrossRefGoogle ScholarPubMed
Trzepacz, P. T., Mittal, D., Torres, R., Kanary, K., Norton, J. and Jimerson, N. (2001). Validation of the Delirium Rating Scale-revised-98: comparison with the Delirium Rating Scale and the cognitive test for delirium. Journal of Neuropsychiatry and Clinical Neurosciences, 13, 229–241.CrossRefGoogle ScholarPubMed
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of post discharge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 304, 443–451.CrossRefGoogle Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.Google Scholar