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Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey

Published online by Cambridge University Press:  19 August 2014

G. Bellelli ,
A. Morandi ,
E. Zanetti ,
M. Bozzini ,
E. Lucchi ,
M. Terrasi  and
M. Trabucchi
G. Bellelli*
Affiliation:
Department of Health Sciences, University of Milano Bicocca and Geriatric Clinic, San Gerardo Hospital, Monza, Italy Geriatric Research Group, Brescia, Italy Milan Center for Neuroscience (Neuro-Mi), Milan, Italy
A. Morandi
Affiliation:
Geriatric Research Group, Brescia, Italy Rehabilitation and Aged Care Unit Hospital Ancelle, Cremona, Italy
E. Zanetti
Affiliation:
Geriatric Research Group, Brescia, Italy
M. Bozzini
Affiliation:
Rehabilitation and Aged Care Unit Hospital Ancelle, Cremona, Italy
E. Lucchi
Affiliation:
Rehabilitation and Aged Care Unit Hospital Ancelle, Cremona, Italy
M. Terrasi
Affiliation:
Unità di Valutazione Multidimensionale, Direzione Infermieristica-Tecnica. Ospedale Morgagni- Pierantoni Forlì
M. Trabucchi
Affiliation:
Geriatric Research Group, Brescia, Italy University of Tor Vergata, Rome, Italy
*
Correspondence should be addressed to: Giuseppe Bellelli, MD, Department of Health Sciences, University of Milano-Bicocca, via Cadore 48, 20900 Monza MB Geriatric Clinic, San Gerardo Hospital, via Pergolesi 33, 20900 Monza MBItaly. Phone: +39 039-233-3475; Fax: +39 039-233-2220. Email: giuseppe.bellelli@unimib.it; giuseppebellelli@libero.it.
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Abstract

Background:

There are no studies that have identified the ability to recognize and manage delirium among Italian health providers caring for patients at risk. Therefore, the Italian Association of Psychogeriatrics (AIP) conducted a multicenter survey among doctors, nurses, psychologists and physiotherapists to assess their competence regarding the theme of delirium and its management in the everyday clinical practice.

Methods:

The survey period was 1st June 2013 to 30th November 2013. The invitation to participate was sent via email, with publication on the AIP website. The survey included 14 questions and two case vignettes.

Results:

A total of 648/1,500 responses were collected. Most responders were doctors (n = 322/800), followed by nurses (n = 225/500), psychologists (n = 51/100), and physiotherapists (n = 30/100). Generally, doctors and psychologists correctly defined delirium, while nurses and physiotherapists did not. The most frequently used diagnostic tools were the Confusion Assessment Method (CAM) and the Diagnostic and Statistical Manual of Mental Disorders-IV. Delirium intensity was rarely assessed. Hypoactive delirium was generally managed with non-pharmacological approaches, while hyperactive delirium with a combination of non-pharmacological and pharmacological approaches. However, possible causes of delirium were under-assessed by half of doctors and by the majority of other professionals. Nurses, psychologists and physiotherapists did not answer the case vignettes, while doctors identified the correct answer in most cases.

Conclusions:

This is the first Italian survey among health providers caring for patients at risk of delirium. This is also the first survey including doctors, nurses, psychologists and physiotherapists. The results emphasize the importance of training to improve knowledge of this relevant unmet medical need.

Keywords

deliriumrecognitionawarenesspsychogeriatricssurveyhealthcare providers
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Special Issue 12: young onset dementia , December 2014 , pp. 2093 - 2102
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Association.Google Scholar
Bellelli, G., et al. (2011). Are fluctuations in motor performance a diagnostic sign of delirium? Journal of the American Medical Directors Association, 12, 578–583.CrossRefGoogle ScholarPubMed
Bellelli, G., et al. (2012). A sudden decline in mobility status as an early sign of acute infection in elderly patients: evidence from three case reports. Aging Clinical and Experimental Research, 24, 281–284.CrossRefGoogle ScholarPubMed
Cadogan, F. L., et al. (2009). Current awareness of delirium in the intensive care unit: a postal survey in the Netherlands. Netherlands Journal of Medicine, 67, 296–300.Google Scholar
Ceraso, D. H., et al. (2010). Latin American survey on delirium in critical patients. Medicina Intensiva, 34, 495–505. doi: 10.1016/j.medin.2010.04.003.CrossRefGoogle ScholarPubMed
Collins, N., et al. (2010). Detection of delirium in the acute hospital. Age Ageing, 39, 131–135.CrossRefGoogle ScholarPubMed
Davis, D. H., et al. (2012). Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain, 135 (Pt 9), 2809–2816.Google Scholar
Davis, D. H. and MacLullich, A. M. J. (2009). Understanding barriers to delirium care: a multicentre survey of knowledge and attitudes amongst UK junior doctors. Age Ageing, 38, 559–563.CrossRefGoogle Scholar
Devlin, J. W., et al. (2011). Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight States. Annals of Pharmacotherapy, 45, 1217–1229.Google Scholar
Elie, M., et al. (2000). Prevalence and detection of delirium in elderly emergency department patients. CMAJ, 163, 977–981.Google Scholar
Ely, E. W., et al. (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Medicine, 27, 1892–1900.CrossRefGoogle ScholarPubMed
Ely, E. W., et al. (2004) Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Critical Care Medicine, 32, 106–112.Google Scholar
Fang, C. K., Chen, H. W., Liu, S. I., Lin, C. J., Tsai, L. Y., and Lai, Y. L. (2008). Prevalence, detection and treatment of delirium in terminal cancer inpatients: a prospective survey. Japanese Journal of Clinical Oncology, 38, 56–63. doi: 10.1093/jjco/hym155.Google Scholar
Fick, D. M., et al. (2007) Recognizing delirium superimposed on dementia: assessing nurses’ knowledge using case vignettes. Journal of Gerontological Nursing, 33, 40–47; quiz 48–49.Google Scholar
Forsgren, L. M. and Eriksson, M. (2010) Delirium–awareness, observation and interventions in intensive care units: a national survey of Swedish ICU head nurses. Intensive and Critical Care Nursing, 26, 296–303.Google Scholar
Inouye, S. K., et al. (2013) Delirium in elderly people. Lancet. pii: S0140-6736(13)60688-1. doi: 10.1016/S0140-6736(13)60688-1.CrossRefGoogle Scholar
Inouye, S. K., et al. (2014) The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Annals of Internal Medicine, 160, 526–533.Google Scholar
Jones, D. S. (2014) Still delirious after all these years. New England Journal of Medicine, 370, 399–401.Google Scholar
Kiely, D. K., et al. (2006) Association between delirium resolution and functional recovery among newly admitted postacute facility patients. Journal of Gerontology Series A Biological Sciences and Medical Sciences, 61, 204–208.Google Scholar
Lee, J., et al. (2013) Perioperative psycho-educational intervention can reduce postoperative delirium in patients after cardiac surgery: a pilot study. International Journal of Psychiatry in Medicine, 45, 143–158.Google Scholar
Lindner, A. U., et al. (2013) Systems analysis of BCL2 protein family interactions establishes a model to predict responses to chemotherapy. Cancer Research, 73, 519–528.Google Scholar
Mac Sweeney, R., et al. (2010) A national survey of the management of delirium in UK intensive care units. Quarterly Journal of Medicine, 103, 243–251.Google Scholar
McCrow, J., et al. (2013) Development and review of vignettes representing older people with cognitive impairment. Geriatric Nursing, 34, 128–137.CrossRefGoogle ScholarPubMed
Morandi, A., et al. (2013) Consensus and variations in opinions on delirium care: a survey of European delirium specialists. International Psychogeriatrics, 25, 2067–2075.CrossRefGoogle Scholar
National Institute of Clinical Excellence, NICE (2012) A summary of selected new evidence relevant to NICE clinical guideline 103 ‘Delirium: diagnosis, prevention and management’.ed, Vol. Evidence Update 14.Google Scholar
O’Mahony, R., et al. (2011) Synopsis of the national institute for health and clinical excellence guideline for prevention of delirium. Annals of Internal Medicine, 154, 746–751.Google Scholar
Ouimet, S., et al. (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Medicine, 33, 66–73.Google Scholar
Pandharipande, P. P., et al. (2013) Long-term cognitive impairment after critical illness. New England Journal of Medicine, 369, 1306–1316.CrossRefGoogle ScholarPubMed
Partridge, J. S., et al. (2012) The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this? International Journal of Geriatric Psychiatry, 28, 804–812.CrossRefGoogle Scholar
Patel, R. P., et al. (2009) Delirium and sedation in the intensive care unit: survey of behaviors and attitudes of 1384 healthcare professionals. Critical Care Medicine, 37, 825–832.Google Scholar
Spronk, P. E., et al. (2009) Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Medicine, 35, 1276–1280.Google Scholar
Tabet, N., et al. (2005) An educational intervention can prevent delirium on acute medical wards. Age Ageing, 34, 152–156.CrossRefGoogle ScholarPubMed
Van Eijk, M. M., et al. (2008) Intensive care delirium monitoring and standardised treatment: a complete survey of Dutch intensive care units. Intensive Critical Care Nursing, 24, 218–221.Google Scholar
Witlox, J., et al. (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 304, 443–451.Google Scholar
Supplementary material: File

Bellelli Supplementary Material

Appendix A

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Supplementary material: File

Bellelli Supplementary Material

Appendix B

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