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Prevalence and risk factors for delirium diagnosis in patients followed in general practices in Germany

Published online by Cambridge University Press:  13 December 2017

Jens Bohlken  and
Karel Kostev
Jens Bohlken
Affiliation:
Praxis für Neurologie und Psychiatrie Bohlken, Berlin, Germany
Karel Kostev*
Affiliation:
Epidemiology, QuintilesIMS, Frankfurt, Germany
*
Correspondence should be addressed to: Prof. Dr. rer. med. Karel Kostev, Epidemiology, QuintilesIMS, Darmstädter Landstraße 108, 60598 Frankfurt, Germany. Phone: +49-(0)69-66 04-4878. Email: kkostev@de.imshealth.com.
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Abstract

Background:

The aim of this study is to identify the prevalence and risk factors of documented delirium in general practices in Germany.

Methods:

The present study includes 2,194 patients over the age of 65 years with delirium and 2,194 controls without delirium from a sample of 6,180,042 patients from 1,262 general practices. Multivariate logistic regression models were fitted with delirium as a dependent variable and other disorders and drugs as potential predictors.

Results:

A five-year-prevalence of 0.08% and an average of 0.7 (SD: 1.5) patients per practice per year were found. Among the study participants, 43.0% were men, and the mean age was 82.2 years (SD = 7.1 years). 24.2% of delirium patients and 10.3% of controls lived in nursing homes. Delirium was found to be positively associated with nursing home residence (OR: 1.69), dementia (OR = 3.45), epilepsy (OR = 2.16), stroke (OR = 1.80), Parkinson's disease (OR = 1.78), sleep disorder (OR = 1.64), renal insufficiency (OR = 1.57), fractures (OR = 1.56), and the prescription of benzodiazepines (OR = 1.62) and antiepileptics (OR = 1.53). Finally, the number of different drug classes prescribed within one year prior to the index date was positively associated with a risk of delirium. Compared to patients without medication therapy, the OR for delirium was 3.21 when more than four drug classes were prescribed.

Conclusions:

In primary care, neuropsychiatric risk factors and polymedication were particularly important for the diagnosis of delirium compared to inpatient care. The methodological limitations of the analysis of data from routine care must be considered. Delirium is rarely diagnosed in primary care. Risk factors in primary care differ from those found in inpatient care. The reasons for this need to be further investigated.

Keywords

deliriumprevalencerisk factorsolder peopleprimary care
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 511 - 518
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Ahmed, S., Leurent, B. and Sampson, E. L. (2014). Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age and Ageing, 43, 326–333.Google Scholar
Alegiakrishnan, K. and Wiens, C. M. (2004). An approach to drug induced delirium in the elderly. Postgraduate Medical Journal, 80, 229–238.Google Scholar
Andrew, M. K., Freter, S. H. and Rockwood, K. (2006). Prevalence and outcomes of delirium in community and non-acute care settings in people without dementia: a report from the Canadian Study of Health and Aging. BMC Medicine, 23, 15.Google Scholar
Arinzon, Z., Peisakh, A., Schrire, S. and Berner, Y. N. (2011). Delirium in long-term care setting: indicator to severe morbidity. Archives of Gerontology and Geriatrics, 52, 270–275.CrossRefGoogle ScholarPubMed
Arumugam, S. et al. (2017). Delirium in the intensive care unit. Journal of Emergencies, Trauma, and Shock, 10, 37–46.Google Scholar
Clegg, A. and Young, J. B. (2011). Which medications to avoid in people at risk of delirium: a systematic review. Age and Ageing, 40, 23–29.Google Scholar
Davis, D. H. et al. (2013). The epidemiology of delirium: challenges and opportunities for population studies. American Journal of Geriatric Psychiatry, 21, 1173–1189.Google Scholar
Davis, D. H. et al. (2014). The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS). BMC Geriatrics, 14, 87.Google Scholar
de Lange, E., Verhaak, P. F. M. and van der Meer, K. (2013). Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. International Journal of Geriatric Psychiatry, 28, 127–134.CrossRefGoogle ScholarPubMed
De Sousa, A. (2008). Psychiatric issues in renal failure and dialysis. Indian Journal of Nephrology, 18, 47–50.CrossRefGoogle ScholarPubMed
Dilling, H., Mombour, W. and Schmidt, M. H. (2014). Klassifikation Psychischer Krankheiten. Klinisch-diagnostische Leitlinien nach Kapitel V (F) der ICD-10, 9th edn. Bern: Huber Verlag.Google Scholar
Dombrwoski, S. and Kostev, K. (2017). Use of Electronic Medical Record in Epidemiological Research. Götttingen: Cuvillier Verlag.Google Scholar
Eichler, T. et al. (2015). Rates of formal diagnosis of dementia in primary care: the effect of screening. Alzheimers Dementia, 29, 87–93.Google Scholar
Fick, D. M., Kolanowski, A. M., Waller, J. L. and Inouye, S. K. (2005). Delirium superimposed on dementia in a community-dwelling managed care population: a 3-year retrospective study of occurrence, costs and utilization. Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, 60, 748–753.Google Scholar
Folstein, M. F., Bassett, S. S., Romanoski, A. J. and Nestadt, G. (1991). The epidemiology of delirium in the community: the Eastern Baltimore mental health survey. International Psychogeriatrics, 3, 169–176.CrossRefGoogle ScholarPubMed
Grover, S. and Kate, N. (2012). Assessment scales for delirium: a review. World Journal of Psychiatry, 22, 58–70.Google Scholar
Inouye, S. K., Westendorp, R. G. J. and Saczynski, J. S. (2014). Delirium in elderly people. Lancet, 383, 911–922.Google Scholar
Jenkin, R. P., Al-Attar, A., Richardson, S., Myint, P. K., MacLullich, A. M. and Davis, D. H. (2016). Increasing delirium skills at the front door: results from a repeated survey on delirium knowledge and attitudes. Age and Ageing, 45, 517–522.CrossRefGoogle ScholarPubMed
Kratz, T., Heinrich, M., Schlauß, E. and Diefenbacher, A. (2015). The prevention of postoperative confusion-a prospective intervention with psychogeriatric liaison on surgical wards in a general hospital. Deutsches Ärzteblatt International, 112, 289–296.Google Scholar
Lixouriotis, C. and Peritogiannis, V. (2011). Delirium in the primary care setting. Psychiatry and Clinical Neurosciences, 65, 102–104.Google Scholar
Naeije, G., Bachir, I., Gaspard, N., Legros, B. and Pepersack, T. (2014). Epileptic activities are common in older people with delirium. Geriatrics & Gerontology International, 14, 447–451.Google Scholar
Oh, E. S. et al. (2015). Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. International Journal of Geriatric Psychiatry, 30, 900–910.Google Scholar
Pendlebury, S. T. et al. (2015). Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission. BMJ Open, 16, e007808. doi: 10.1136/bmjopen-2015-007808.Google Scholar
Pendlebury, S. T., Lovett, N. G., Smith, S.C., Wharton, R. and Rothwell, P. M. (2017). Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of a susceptibility score based on factors identified externally in pooled data for use at entry to the acute care pathway. Age and Ageing, 46, 226–231.Google Scholar
Peritogiannis, V., Bolosi, M., Lixouriotis, C. and Rizos, D. V. (2015). Recent insights on prevalence and corelations of hypoactive Delirium. Behavioural Neurology, doi: 10.1155/2015/416792. Epub 2015 Aug 10.CrossRefGoogle ScholarPubMed
Rahkonen, T. et al. (2001). Delirium in the nondemented oldest old in the general population: risk factors and prognosis. International Journal of Geriatric Psychiatry, 16, 415–421.Google Scholar
Richardson, S. J. et al. (2017). Detecting delirium superimposed on dementia: diagnostic accuracy of a simple combined arousal and attention testing procedure. International Psychogeriatrics, 29, 1585–1593.Google Scholar
Robinson, T. N. and Eiseman, B. (2008). Postoperative delirium in the elderly: diagnosis and management. Clinical Interventions in Aging, 3, 351–355.Google Scholar
Shi, Q., Presutti, R., Selchen, D. and Saposnik, G. (2012). Delirium in acute stroke: a systematic review and meta-analysis. Stroke, 43, 645–649.CrossRefGoogle ScholarPubMed
Terzaghi, M., Sartori, I., Rustioni, V. and Manni, R. (2014). Sleep disorders and acute nocturnal delirium in the elderly: a comorbidity not to be overlooked. European Journal of Internal Medicine, 25, 350–355.Google Scholar
van Velthuijsen, E. L., Zwakhalen, S. M., Warnier, R. M., Mulder, W. J., Verhey, F.R. and Kempen, G. I. (2016). Psychometric properties and feasibility of instruments for the detection of delirium in older hospitalized patients: a systematic review. International Journal of Geriatric Psychiatry, 31, 974–989.Google Scholar
Vardy, E. R, Teodorczuk, A. and Yarnall, A. J. (2015). Review of delirium in patients with Parkinson's disease. Journal of Neurology, 262, 2401–2410.Google Scholar
Vasilevskis, E. E, Han, J. H., Hughes, C. G. and Ely, E. W. (2012). Epidemiology and risk factors for delirium across hospital settings. Best Practice & Research Clinical Anaesthesiology, 26, 277–287.Google Scholar
Vilalta-Franch, J., Llinàs-Reglà, J., López-Pousa, S. and Garre-Olmo, J. (2009). Prevalence and evolution of delirium in a community population of 70 years and older. Actas Españolas de Psiquiatría, 37, 27–33.Google Scholar
Woodford, H. J, George, J. and Jackson, M. (2015). Non-convulsive status epilepticus: a practical approach to diagnosis in confused older people. Postgraduate Medical Journal, 91, 655–661.Google Scholar
Yang, Y., Zhao, X., Dong, T., Yang, Z, Zhang, Q. and Zhang, Y. (2017). Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clinical and Experimental Research, 29, 115–126.Google Scholar