Incidence and Risk Factors of Acute Confusional State in Hospitalized Older Patients

Main Article Content

Tipanetr Ngamkala
Porntip Malathum
Orapichaya Krairit

Abstract

Abstract:
Acute confusional state is a common phenomenon associated with acute
illness in hospitalized older patients. It independently predicts undesirable hospital
outcomes, higher costs of care, prolonged hospital stays, higher mortality, and greater
discharge to nursing homes. The purpose of this study was to explore the incidence rate
and risk factors of acute confusional state at Ramathibodi Hospital, Thailand.
This prospective descriptive study was conducted between January and April 2016 in
179 patients, aged 60 years and older, admitted to general medical wards. The Confusion
Assessment Method and the Risk Factor of Acute Confusional State Checklist were daily
used to assess acute confusional state and its risk factors, respectively. The average age
of the sample ranged from 64 to 89 years (M = 80.52). Most presenting signs and
symptoms found on admission were related to the respiratory problem (39.13%).
The incidence of acute confusional state was 12.85%. The acute confusional state was
found on Day1 to Day4 and its duration was from 2 to 12 days. Common risk factors
for acute confusional state were multifactorial, including infection, dehydration,
electrolyte imbalance, pain, and hypoxemia, respectively. All of the sample had more
than two risk factors. This study can be used as baseline data for prevention and
management of acute confusional state in hospitalized older patients.



Keywords: Incidence rate, Risk factors, Acute confusional state, Hospitalized older
patients

Article Details

How to Cite
1.
Ngamkala T, Malathum P, Krairit O. Incidence and Risk Factors of Acute Confusional State in Hospitalized Older Patients. Nurs Res Inno J [Internet]. 2018 Oct. 4 [cited 2024 Apr. 20];24(2):137-49. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/148777
Section
บทความวิจัย

References

1. Caplan GA, Kurrle SE, Cumming A. Appropriate care for older people with cognitive impairment in hospital. Med
J Aust. 2016;205(10):S12-15.

2. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention, and treatment. Nat Rev
Neurol. 2009;5(4):210-20.

3. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911-22.

4. Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, et al. Subsyndromal delirium in older longterm
care residents: incidence, risk factors, and outcomes.J Am Geriatr Soc. 2011;59(10):1829-36.

5. Faught DD. Delirium: the nurse’s role in prevention, diagnosis, and treatment.Medsurg Nurs. 2014;23
(5):301-5.

6. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354(11):1157-65.

7. Northamptonshire Healthcare MMG033. Guideline for diagnosis, prevention, and treatment of delirium in the
inpatient setting. NHS Foundation Trust. 2012;1-14.

8. Sendecki C. The importance of identifying delirium in older adults in the ED: impacts on mortality and quality of
life. J Emerg Nurs. 2014;37(1):25-27.

9. Beary T. Delirium prevention: early recognition and treatment. NRC. 2013;15(8):547-51.

10. Kukreja D, Gunther U, Popp J. Delirium in the elderly: current problems with increasing geriatric age. Indian J
Med Res. 2015;142(6):655-62.

11. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic
literature review. Age Ageing. 2006; 35(4):350-64.

12. Lorenzl S, Fusgen I, Noachtar S. Acute confusional state in the elderly-diagnosis and treatment. Dtsch Arztebl Int.
2012;109(21):391-9.

13. Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advance in diagnosis and treatment. JAMA.
2017; 318(12):1161-74.

14. Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. Jm American Geriatr Soc.
2011;59(52):S241-3.

15. Arend E, Christensen M. Delirium in the intensive care unit: a review. Nurs Crit Care. 2009;14(3)145-54.

16. Michaud L, Bula C, Berney A, Camus V, Voellinger R, Stiefel F, Burnand B. Delirium: guidelines for general
hospitals. J Psychosom Res. 2007; 62:371-81.

17. Phillips LA. Delirium in geriatric patients: identification and prevention. Medsurg Nurs. 2013;22(1):9-12.

18. Rigney TS. Delirium in the hospitalized elder and recommendations for practice. Geriatr Nurs.
2006;27(3):151-7.

19. Ramathibodi Statistics. (2014). Faculty of Medicine Ramathibodi Hospital, Mahidol University. (in Thai)

20. National Institute for Health and Clinical Excellence. Delirium: diagnosis, prevention and management. National Clinical Guideline Centre. 2010;103:1-33.

21. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model
and interrelationship with baseline vulnerability. JAMA Intern Med. 1996;275(11):852-57.

22. Munster BC, de Rooij SE. Delirium: a synthesis of current knowledge. Clin Med. 2014;14(2):192-5.

23. Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for intensive care
delirium: a systematic review. Intensive Crit Care Nurs. 2008;24(2):98-107.

24. Voyer P, McCusker J, Cole MG, St-Jacques S, Khomenko L. Factors associated with delirium severity among older
patients. J Clin Nurs. 2007;16(5):819-31.

25. Wand AP, Thoo W, Sciuriaga H, Ting V, Baker J, Hunt GE. A multifaceted educational intervention to prevent
delirium in older inpatients: a before and after study. Int J Nurs Stud. 2014;51(7):974-82.

26. Matata C, Defres S, Jones C, Gummery A, Solomon T. Management of acute confusion in patients with CNS
infections. Nurs Stand. 2013;28(15):49-58.

27. Phillips LA. Delirium in geriatric patients: identification and prevention. Medsurg Nurs. 2013;22(1):9-12.

28. Jeangsawang N, Malathum P, Aree-Ue S, Chansirikarnjana,S. Factors predicting length of hospital stay of medical
older patients units in Ramathibodi Hospital. Rama Nurs J. 2007;13(3):405-26. (in Thai)

29. Boonphadh P. The incidence of acute confusional states and associated factors in postoperative elderly patients
[Master's Thesis]. Bangkok: Mahidol University; 2004.(in Thai)

30. Oearsakul B. The incidence and factors related to acute confusional states in hospitalized elderly patients. Rama
Nurs J. 2002;8(3):209-23. (in Thai)

31. Kumniyom N. Acute confusional states and factors related to acute confusion in older persons during in hospitalization [Master's Thesis]. Khon Kaen: Khon Kaen University;2006. (in Thai)

32. Tejangkura L. Factors related to delirium in adult patients undergoing open heart surgery [Master's Thesis]. Bangkok:Mahidol University; 2007. (in Thai)