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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*
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.

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.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2011

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