Skip to main content Accessibility help
×
Home

Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents

  • Martin G. Cole (a1) (a2), Jane McCusker (a2) (a3), Philippe Voyer (a4), Johanne Monette (a5) (a6), Nathalie Champoux (a7), Antonio Ciampi (a2) (a3), Eric Belzile (a2) and Minh Vu (a8) (a9)...

Abstract

Background:

The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents.

Methods:

The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM – defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations.

Results:

Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia.

Conclusion:

CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.

Copyright

Corresponding author

Correspondence should be addressed to: Dr. Martin G. Cole, Department of Psychiatry, St. Mary's Hospital Center, 3830 Avenue Lacombe, Montreal, Quebec H3T 1M5, Canada. Phone: +514-345-3511; ext. 3839; Fax: +514-734-2652. Email: martin.cole@ssss.gouv.qc.ca.

References

Hide All
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for depression in dementia. Biological Psychiatry, 23, 271284.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th Text Revision DSM-IV-TR). Washington, DC: American Psychiatric Publishing, Inc.
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, R. C. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373383.
Cole, M. G., McCusker, J., Dendukuri, N. and Han, L. (2002). Symptoms of delirium among elderly medical inpatients with or without dementia. Journal of Neuropsychiatry and Clinical Neurosciences, 14, 167175.
Cole, M. G. et al. (2011). Subsyndromal delirium in older long-term care residents: incidence, risk factors, and outcomes. Journal of the American Geriatrics Society, 59, 18291836.
Cole, M. G. et al. (2012). Symptoms of delirium occurring before and after episodes of delirium in older long-term care residents. Journal of the American Geriatrics Society, 60, 23022307.
Cole, M. G. et al. (2013). Symptoms of delirium predict incident delirium in older long-term care residents. International Psychogeriatrics, 25, 887894.
Fitzmaurice, G. M., Laird, N. M. and Ware, J. H. (2004). Applied Longitudinal Analysis. Hoboken, NJ: John Wiley & Sons Inc.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Fries, B. E., Mehr, D. R., Schneider, D., Foley, W. J. and Burke, R. (1993). Mental dysfunction and resource use in nursing homes. Medical Care, 31, 898920.
Inouye, S. K. et al. (1990). Clarifying confusion: the Confusion Assessment Method, a new method for detection of delirium. Annals of Internal Medicine, 113, 941948.
Kiely, D. K. et al. (2003). Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences, 58, M441–M445.
Korner, A. et al. (2006). The geriatric depression scale and the cornell scale for depression in dementia. A validity study. Nordic Journal of Psychiatry, 60, 360364.
Landreville, P., Voyer, P. and Carmichael, P. H. (2013). Relationship between delirium and behavioral symptoms of dementia. International Psychogeriatrics, 25, 635643.
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel index. Maryland State Medical Journal, 14, 6165.
McCusker, J., Cole, M. G., Dendukuri, N. and Belzile, E. (2004). The delirium Index: a measure of the severity of delirium: new findings on reliability, validity and responsiveness. Journal of the American Geriatrics Society, 52, 17441749.
McCusker, J. et al. (2011a). Prevalence and incidence of delirium in long-term care. International Journal of Geriatric Psychiatry, 26, 11521161.
McCusker, J. et al. (2011b). Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium. International Psychogeriatrics, 23, 602608.
McCusker, J. et al. (2013). Environmental factors predict the severity of delirium symptoms in long-term care residents with and without delirium. Journal of the American Geriatrics Society, 61, 502511.
Meagher, D. J. et al. (2010). A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Journal of Neurology, Neurosurgery, and Psychiatry, 81, 876881.
Pan, W. (2001). Akaike's information criterion in generalized estimating equations. Biometrics, 57, 120125.
Pitkala, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2005). Prognostic significance of delirium in frail older people. Dementia and Geriatric Cognitive Disorders, 19, 158163.
Ray, W. A., Taylor, J. A., Lichtenstein, M. J. and Meador, K. G. (1992). The Nursing Home Behavior Problem Scale. Journal of Gerontology, 47, M916.
Rovner, B. W., German, P. S., Broadhead, J., Morriss, R. K. and Brant, L. J. (1990). The prevalence and management of dementia and other psychiatric disorders in nursing homes. International Psychogeriatrics, 2, 1324.
Sandberg, O., Gustafson, Y., Brannstrom, B. and Bucht, G. (1998). Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scandinavian Journal of Social Medicine, 26, 5662.
Shah, S., Vanclay, F. and Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42, 703709.
Sourial, R., McCusker, J., Cole, M. G. and Abrahamowicz, M. (2001). Agitation in demented patients in an acute care hospital: Prevalence, disruptiveness and staff burden. International Psychogeriatrics, 13, 183197.
Voyer, P., Richard, S., Doucet, L. and Carmichael, P. (2009). Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents. Journal of the American Medical Directors Association, 10, 181188.
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649655.
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632638.

Keywords

Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents

  • Martin G. Cole (a1) (a2), Jane McCusker (a2) (a3), Philippe Voyer (a4), Johanne Monette (a5) (a6), Nathalie Champoux (a7), Antonio Ciampi (a2) (a3), Eric Belzile (a2) and Minh Vu (a8) (a9)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed