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Assessment of inattention in the context of delirium screening: one size does not fit all!

Published online by Cambridge University Press:  23 March 2016

Philippe Voyer ,
Nathalie Champoux ,
Johanne Desrosiers ,
Philippe Landreville ,
Johanne Monette ,
Maryse Savoie ,
Pierre-Hugues Carmichael ,
Sylvie Richard  and
Annick Bédard
Philippe Voyer*
Affiliation:
Faculty of Nursing Sciences, Laval University, Quebec City, Quebec, Canada Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
Nathalie Champoux
Affiliation:
Department of Family Medicine, Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Quebec, Canada
Johanne Desrosiers
Affiliation:
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
Philippe Landreville
Affiliation:
School of Psychology, Laval University, Quebec City, Quebec, Canada
Johanne Monette
Affiliation:
Division of Geriatric Medicine, Jewish General Hospital and Donald Berman Maimonides Geriatric Center, Montreal, Quebec, Canada
Maryse Savoie
Affiliation:
Ste. Anne Hospital, Ste-Anne de Bellevue, Quebec, Canada
Pierre-Hugues Carmichael
Affiliation:
Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
Sylvie Richard
Affiliation:
Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
Annick Bédard
Affiliation:
Centre for Excellence in Aging-Research Unit, Quebec City, Quebec, Canada
*
Correspondence should be addressed to: Dr P. Voyer, Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 3445, 1050, rue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada. Phone: +1-418-656-2131, Ext.: 8799; Fax: +1-418-656-7747. Email: philippe.voyer@fsi.ulaval.ca.
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Abstract

Background:

Despite its high prevalence and deleterious consequences, delirium often goes undetected in older hospitalized patients and long-term care (LTC) residents. Inattention is a core symptom of this syndrome. The aim of this study was to explore the usefulness of ten simple and objective attention tests that would enable efficient delirium screening among this population.

Methods:

This was a secondary analysis (n = 191) of a validation study conducted in one acute care hospital (ACH) and one LTC facility among older adults with, or without, cognitive impairment. The attention test tasks (n = 10) were drawn from the Concentration subscale the Hierarchic Dementia Scale (HDS). Delirium was defined as meeting the criteria for DSM-5 delirium. The Confusion Assessment Method (CAM) was used to determine the presence of delirium symptoms.

Results:

The Months of the Year Backward (MOTYB) test, which 57% of participants completed successfully, showed the best balance between sensitivity and specificity (82.6%; 95% CI [61.2–95.0], and 62.5%; 95% CI [54.7–69.8] respectively) for the entire group. Subgroup analyses revealed that no test had both sensitivity and specificity over 50% in participants with cognitive impairment indicated in their medical chart.

Conclusions:

Our results revealed that these tests varied greatly in performance and none can be earmarked to become a single-item screening tool for delirium among older patients and residents with, or without, cognitive impairment. The presence of premorbid cognitive impairment may necessitate more extensive assessments of delirium, especially when a change in general status or mental state is observed.

Keywords

deliriumattentionscreeningelderlylong-term careacute carecognitive impairment
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 8 , August 2016 , pp. 1293 - 1301
Copyright
Copyright © International Psychogeriatric Association 2016 

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