Background: Delirium is a common geriatric syndrome. Few studies have been conducted in nursing home (NH) residents. The aim of this project was to perform a point prevalence study of delirium in Italian NHs. Methods: Data collected in 71 NHs are presented. Inclusion criteria were age ≥65 years and native Italian speaker. Exclusion criteria were coma, aphasia, and end-of-life status. Sociodemographic and medical data were recorded. Delirium was assessed using the Assessment Test for Delirium and Cognitive Impairment (4-AT). Patients with a 4-AT score ≥4 were considered to have delirium. Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS). Results: A total of 1,454 patients were evaluated (mean age 84.4 ± 7.4 years, 70.2% female), of whom 535 (36.8%) had delirium. In multivariate logistic regression analysis, variables significantly associated with delirium were education (OR 0.94, 95% CI 0.91–0.97), dementia (OR 3.12, 95% CI 2.38–4.09), functional dependence (OR 6.13, 95% CI 3.08–12.19 for ADL score 0; OR 1.99, 95% CI 1.03–3.84 for ADL score 1–5), malnutrition (OR 4.87, 95% CI 2.68–8.84), antipsychotics (OR 2.40, 95% CI 1.81–3.18), and physical restraints (OR 2.48, 95% CI 1.71–3.59). Conclusion: Delirium is common in older NH residents. Simple assessment tools might facilitate its recognition in this vulnerable population.

1.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Arlington, American Psychiatric Association, 2013.
2.
Inouye SK, Westendorp RG, Saczynski JS: Delirium in elderly people. Lancet 2014; 383: 911–22.
3.
Krogseth M, Wyller TB, Engedal K, Juliebø V: Delirium is an important predictor of incident dementia among elderly hip fracture patients. Dement Geriatr Cogn Disord 2011; 31: 63–70.
4.
Kat MG, Vreeswijk R, de Jonghe JFM, van der Ploeg T, van Gool WA, Eikelenboom P, Kalisvaart KJ: Long-term cognitive outcome of delirium in elderly hip surgery patients. Dement Geriatr Cogn Disord 2008; 26: 1–8.
5.
Wacker P, Nunes PV, Cabrita H, Forlenza OV: Post-operative delirium is associated with poor cognitive outcome and dementia. Dement Geriatr Cogn Disord 2006; 21: 221–227.
6.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA: Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010; 304: 443–451.
7.
Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS: Prognostic significance of delirium in frail older people. Dement Geriatr Cogn Disord 2005; 19: 158–163.
8.
Morandi A, Lucchi E, Turco R, Morghen S, Guerini F, Santi R, Gentile S, Meagher D, Voyer P, Fick DM, Schmitt EM, Inouye SK, Trabucchi M, Bellelli G: Delirium superimposed on dementia: a quantitative and qualitative evaluation of informal caregivers and health care staff experience. J Psychosom Res 2015; 79: 272–280.
9.
Morandi A, Lucchi E, Turco R, Morghen S, Guerini F, Santi R, Gentile S, Meagher D, Voyer P, Fick DM, Schmitt EM, Inouye SK, Trabucchi M, Bellelli G: Delirium superimposed on dementia: a quantitative and qualitative evaluation of patient experience. J Psychosom Res 2015; 79: 281–287.
10.
Clegg A, Westby M, Young JB: Under-reporting of delirium in the NHS. Age Ageing 2011; 40: 283–286.
11.
Abraha I, Trotta F, Rimland JM, Cruz-Jentoft A, Lozano-Montoya I, Soiza RL, Pierini V, Dessi Fulgheri P, Lattanzio F, O’Mahony D: Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP Series. PLoS One 2015; 10:e0123090.
12.
Bellelli G, Morandi A, Trabucchi M, Caironi G, Coen D., Fraticelli C, Paolillo C, Prevaldi C, Riccardi A, Cervellin G, Carabellese C, Putignano S, Cherubini A, Gnerre P, Fontanella A, Latronico N, Tommasino C, Corcione A, Ricevuti G, Ferrara N, De Filippi F, Ferrari Guarino AM, Ruggieri MP, Modesti PA, Perticone F, Locatelli C, Hrelia P, Toscano MO, Bondi E, Tarasconi A, Ansaloni L, Maggi S: Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons. Eur Geriatr Med 2017; 8: 293–298.
13.
Cole MG, McCusker J, Voyer P, Monette J, CHampoux N, Ciampi A, Vu M, Belzile E: The course of delirium in older long-term care residents. Int J Geriatr Psychiatry 2012; 27: 1291–1297.
14.
de Lange E, Verhaak PF, van der Meer K: Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. Int J Geriatr Psychiatry 2013; 28: 127–134.
15.
Bellelli G, Morandi A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Bianchetti A, Rozzini R, Zanetti E, Musicco M, Ferrari A, Ferrara N, Trabucchi M; Italian Study Group on Delirium (ISGoD): “Delirium Day”: a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med 2016; 14: 106.
16.
Bellelli G, Morandi A, Davis DH, Mazzola P, Turco R, Gentile S, Ryan T, Cash H, Guerini F, Torpilliesi T, Del Santo F, Trabucchi M, Annoni G, MacLullich AM: Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 2014; 43: 496–502.
17.
Meagher DJ, Moran M, Raju B, Gibbons D, Donnelly S, Saunders J, Trzepacz PT: Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods. Psychosomatics 2008; 49: 300–383.
18.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist 1970; 10: 20–30.
19.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–378.
20.
Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS: The impact of different diagnostic criteria on prevalence rates for delirium. Dement Geriatr Cogn Disord 2003; 16: 156–162.
21.
McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E: Prevalence and incidence of delirium in long-term care. Int J Geriatr Psychiatry 2011; 26: 1152–1161.
22.
Voyer P, Richard S, Doucet L, Cyr N, Carmichael PH: Examination of the multifactorial model of delirium among long-term care residents with dementia. Geriatr Nurs 2010; 31: 105–114.
23.
Dosa D, Intrator O, McNicoll L, Cang Y, Teno J: Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set. J Am Geriatr Soc 2007; 55: 1099–1105.
24.
Mentes J, Culp K, Maas M, Rantz M: Acute confusion indicators: risk factors and prevalence using MDS data. Res Nurs Health 1999; 22: 95–105.
25.
Boorsma M, Joling KJ, Frijters DH, Ribbe ME, Nijpels G, van Hout HP: The prevalence, incidence and risk factors for delirium in Dutch nursing homes and residential care homes. Int J Geriatr Psychiatry 2012; 27: 709–715.
26.
Morandi A, Davis D, Bellelli G, Arora RC, Caplan GA, Kamholz B, Kolanowski A, Fick DM, Kreisel S, MacLullich A, Meagher D, Neufeld K, Pandharipande PP, Richardson S, Slooter AJ, Taylor JP, Thomas C, Tieges Z, Teodorczuk A, Voyer P, Rudolph JL: The diagnosis of delirium superimposed on dementia: an emerging challenge. J Am Med Dir Assoc 2017; 18: 12–18.
27.
Brown LJ, Fordyce C, Zaghdani H, Starr JM, MacLullich AM: Detecting deficits of sustained visual attention in delirium. J Neurol Neurosurg Psychiatry 2011; 82: 1334–1340.
28.
Meagher DJ, Leonard M, Donnelly S, Conroy M, Saunders J, Trzepacz PT: A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls. J Neurol Neurosurg Psychiatry 2010; 81: 876–881.
29.
Inouye SK, Ferrucci L: Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia. J Gerontol A Biol Sci Med Sci 2006; 61: 1277–1280.
30.
Landreville P, Voyer P, Carmichael PH: Relationship between delirium and behavioral symptoms of dementia. Int Psychogeriatr 2013; 25: 635–643.
31.
Macdonald AJ: Can delirium be separated from dementia? Dement Geriatr Cogn Disord 1999; 10: 386–388.
32.
Bellelli G, Frisoni GB, Turco R, Lucchi E, Magnifico F, Trabucchi M: Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility. J Gerontol A Biol Sci Med Sci 2007; 62: 1306–1309.
33.
Wei LA, Fearing MA, Sternberg EJ, Inouye SK: The Confusion Assessment Method: a systematic review of current usage. J Am Geriatr Soc 2008; 56: 823–830.
34.
Von Gunten A, Mosimann UP: Delirium upon admission to Swiss nursing homes: a cross-sectional study. Swiss Med Wkly 2010; 140: 376–381.
35.
Kiely DK, Bergmann MA, Murphy KM, Jones RN, Orav EJ, Marcantonio ER: Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol A Biol Sci Med Sci 2003; 58:M441–M445.
36.
Lattanzio F, Mussi C, Scafato E, Ruggiero C, Dell’Aquila G, Pedone C, Mammarella F, Galluzzo L, Salvioli G, Senin U, Carbonin PU, Bernabei R, Cherubini A; U.L.I.S.S.E. Study Group: Health care for older people in Italy: The U.L.I.S.S.E. Project (Un link informatico sui servizi sanitari esistenti per l’anziano – a computerized network on health care services for older people). J Nutr Health Aging 2010; 14: 238–242.
37.
Landi F, Gambassi G, Lapane KL, Sgadari A, Gifford D, Mor V, Bernabei R: Comorbidity and drug use in cognitively impaired elderly living in long-term care. Dement Geriatr Cogn Disord 1998; 9: 347–356.
38.
Meagher DJ, McLoughlin L, Leonard M, Hannon N, Dunne C, O’Regan N: What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy. Am J Geriatr Psychiatry 2013; 21: 1223–1238.
39.
Mussi C, Ferrari R, Ascari S, Salvioli G: Importance of serum anticholinergic activity in the assessment of elderly patients with delirium. J Geriatr Psychiatry Neurol 1999; 12: 82–86.
40.
Simoni-Wastila L, Wei YJ, Lucas JA, Brandt N, Moyo P, Huang TY, Franey CS, Harris I: Mortality risk of antipsychotic dose and duration in nursing home residents with chronic or acute indications. J Am Geriatr Soc 2016; 64: 973–980.
41.
National Clinical Guideline Centre: Risk factors for delirium: pharmacological agents; in: Delirium: Diagnosis, Prevention and Management (NICE Clinical Guidelines, No. 103). London, Royal College of Physicians, 2010. https://www.ncbi.nlm.nih.gov/books/NBK65564/A.
42.
Clegg A, Young JB: Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing 2011; 40: 23–29.
43.
Pisani MA, Murphy TE, Van Ness PH, Araujo KLB, Inouye SK: Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007; 167: 1629–1634.
44.
Veronese A, Garatti M, Cipriani A, Barbui C: Benzodiazepine use in the real world of psychiatric practice: low-dose, long-term drug taking and low rates of treatment discontinuation. Eur J Clin Pharmacol 2007; 63: 867–873.
45.
Magrini N, Vaccheri A, Parma E, Dí Alessandro R, Bottoni A, Occhionero M, Montanaro N: Use of benzodiazepines in the Italian general population: prevalence, pattern of use and risk factors for use. Eur J Clin Pharmacol 1996; 50: 19–25.
46.
Balestrieri M, Marco G, Samani F, Marini M, Sessa E, Gelatti U, Donato F: Mental disorders associated with benzodiazepine use among older primary care attenders. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 308–315.
47.
Helvik AS, Engedal K, Benth JŠ, Selbæk G: Prevalence and severity of dementia in nursing home residents. Dement Geriatr Cogn Disord 2015; 40: 166–177.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.