Acute Confusional State and Management by Healthcare Personnel among Medical Elderly Patients in a Tertiary Care Hospital

Main Article Content

Chulaluk Jaipang
Porntip Malathum
Nuchanad Sutti
Yuttachai Likitjaroen


Acute confusional state (ACS) is a common condition in hospitalized elderly patients.However, little is known about the prevalence and incidence, and how healthcare personnel manage the ACS in hospitalized elderly patients. This prospective descriptive study aimed to explore the prevalence and incidence of ACS in elderly patients, and management by the healthcare personnel in elderly patients with ACS admitted to medical wards. Purposive sampling was used to recruit a sample of 192 elderly patients in medical wards at a tertiary hospital, and consecutive sampling was used to recruit a sample of 31 healthcare personnel working in those wards. The data collection was conducted from August to November 2018, using questionnaires and assessment forms. The data were analyzed using descriptive statistics, Chi-square, and content analysis. The point prevalence rate of ACS in elderly patients at admission was 3.65%, while its incidence was 5.21%, so the period prevalence rate was 8.85%. Risk factors associated with ACS included dementia, hypoxemia, advanced age,infection, and insomnia. For management by physicians, all elderly participants received medical
treatment to minimize risk factors of ACS. The management by other healthcare personnel included
participation in the treatment of underlying causes, managing ACS behaviors, prevention of complications, and restoration of functions. In addition, facilitators for management included family participation in patient care, the interdisciplinary team, care management guidelines, and educational training. Barriers to management consisted of workload and inadequate experience or knowledge of the personnel. Findings suggest that healthcare personnel should proactively assess, prevent, and manage ACS in elderly patients to resume normal as soon as possible.


Download data is not yet available.

Article Details

How to Cite
Jaipang C, Malathum P, Sutti N, Likitjaroen Y. Acute Confusional State and Management by Healthcare Personnel among Medical Elderly Patients in a Tertiary Care Hospital. Rama Nurs J [Internet]. 2020Aug.28 [cited 2020Dec.5];26(2):124-37. Available from:


1. Breitbart W, Gibson C, Tremblay A. The delirium experience: delirium recall and delirium related distress in
hospitalized patients with cancer, their spouses/caregivers,and their nurses. Psychosomatics. 2002;43(3):183-94.

2. Praditsuwan R, Limmathuroskul D, Assanasen J,Pakdeewongse S, Eiamjinnasuwat W, Sirisuwat A, et al.
Prevalence and incidence of delirium in Thai older patients:a study at general medical wards in Siriraj Hospital. J Med Assoc Thai. 2012;95 Suppl 2:S245-50.

3. Inouye SK. Delirium in Older Persons. N Engl J Med.2006;354(11):1157–65.

4. Oearsakul B, Intarasombat P, Zartrungpak S. The incidence and factors related to acute confusional states in hospitalized elderly patients. Rama Nurs J. 2002;8(3):209-22. (inThai)

5. Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing.2014; 43(3):326-33.

6. Eiamthanasinchai S. Factors associated with delirium of hospitalized patients in medical ward. Medical Journal of Srisaket Surin Burirum Hospital. 2013;28(3):159-68. (in Thai)

7. McCusker J, Cole MG, Dendukuri N, Belzile E. Does delirium increase hospital stay? J Am Geriatr Soc.

8. Inouye SK, Rushing JT, Foreman MD, Palmer RM,Pompei P. Does delirium contribute to poor hospital
outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13(4): 234-42.

9. Muangpaisan W. Delirium in the elderly and prevention.In Assantachai P, editors. Health Problem in the Elderly and Prevention. 2nd ed. Bangkok: Union Creation; 2011.p. 113-27. (in Thai)

10. Limpawattana P, Sutra S, Thavornpitak Y, Sawanyawisuth K, Chindaprasirt J, Mairieng P. Delirium in hospitalized elderly patients of Thailand; is the figure underrecognized?J Med Assoc Thai. 2012;95 Suppl 7:S224-8.

11. Collier R. Hospital-induced delirium hits hard. Can Med Assoc J. 2012; 184(1):23–4.

12. Tampi RR, Tampi DJ, Barua S, Chandran S. Management of delirium in the elderly patients: a review of evidence. J. Drug Abuse. 2015;1(1:6):1-12.

13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed).
United States of America: British Library; 2013. p. 596-601.

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

15. Cerejeira J, Mukaetova-Ladinska EB. A clinical update on delirium: from early recognition to effective
management. Nurs Res Pract. 2011;20(11): 1-12. doi:10.1155/2011 /875196

16. Kalish VB, Gillham JE, Unwin BK. Delirium in older persons: evaluation and management. Am Fam Physician.

17. Yevchak AM, Steis M, Diehl T, Hill N, Kolanowski A,Fick D. Managing delirium in the acute care setting: a pilot
focus group study. Int J Older People Nurs.2012;7(2):152–62.

18. Bonita R, Beaglehole R, Kjellstrom T. Basic epidemiology.2nd ed. Switzerland: WHO Press; 2006.

19. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion
assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-48.

20. Wongpakaran N, Wongpakaran T, Bookamana P, et al. Diagnosing delirium in elderly Thai patients: utilization
of the CAM algorithm. BMC Fam Pract.2011;12(1):1-5.doi: 10.1186/1471-2296-12-65.

21. Yuwapattanawong N, Leungratanamart L. Assessment and nursing care delirium in elderly patients who have
undergone surgery. Veridian E-Journal Science and Technology Silpakorn University. 2016;3(6):101-12.
(in Thai)

22. van de Steeg L, Langelaan M, Ijkema R, Nugus P, Wagner C. Improving delirium care for hospitalized older patients.a qualitative study identifying barriers to guideline adherence. J Eval Clin Pract. 2014;20(6):813-9.

23. Ngamkala T, Malathum P, Krairit O. Incidence and risk factors of acute confusional state in hospitalized older
patients. Rama Nurs J. 2018;24(2):137-49. (in Thai)

24. Perese EF. Psychiatric advanced practice nursing: A biopsychosocial foundation for practice. Philadelphia, PA.
F.A. Davis; 2012.

25. Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly
medical patients based on admission characteristics. Ann Intern Med. 1993;119(6):474-81.

26. Alagiakrishnan K, Wiens C. An approach to drug induced delirium in the elderly. Postgrad Med J. 2004;80

27. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823–32. doi:10.1016 /S14 74-4422(15)00101-5.

28. Cunningham C. Systemic inflammation and delirium:important co-factors in the progression of dementia.
Biochem Soc Trans. 201;39(4):945-53.

29. Ritter C, Tomasi CD, Dal-Pizzol F, Pinto BB, Dyson A,de Miranda AS, et al. Inflammation biomarkers and
delirium in critically ill patients. Crit Care. 2014;18(3):1-6. doi: 10.1186/cc13887.

30. Ali S, Patel M, Jabeen S, Bailey RK, Patel T, Shahid M,et al. Insight into delirium. Innov Clin Neurosci.

31. Maldonado JR. Pathoetiological model of delirium: a comprehensive understanding of the neurobiology of
delirium and an evidence-based approach to prevention and treatment. Crit Care Clin. 2008;24(4):789-856.

32. Watson PL, Ceriana P, Fanfulla F. Delirium: Is sleep important? Best Pract Res Clin Anaesthesiol.

33. Weinhouse GL, Schwab RJ, Watson PL, et al. Bench-tobedside review: delirium in ICU patients-importance of
sleep deprivation. Crit Care. 2009;13(6):234.doi:10.1186/cc8131.

34. Trzepacz PT, Breitbart CW, Franklin J, Levenson J,Martini R, Wang P. Practice guideline for the treatment of
patients with delirium. United States of America: American Psychiatric Association; 2010.

35. Lonergan E, Britton AM, Luxenberg J. Antipsychotics for delirium. Cochrane Database Syst Rev. 2007;18(2):
1-2. doi: 10.1002/14651858. CD005594.pub2.

36. Carr FM. The role of sitters in delirium: an update. Can Geriatr J. 2013;16(1):22-36.

37. Lakatos BE, Capasso V, Mitchell MT, Kilroy SM,Lussier-Cushing M, Sumner L, et al. Falls in the general
hospital: association with delirium, advanced age, and specific surgical procedures. Psychosomatics.

38 Kolanowski A, Fick D, Litaker M, Mulhall P, Clare L, Hill N, et al. Effect of cognitively stimulating activities on
symptom management of delirium superimposed on dementia: a randomized controlled trial. J Am Geriatr Soc.
2016;64(12):2424-32. doi: 10.1111 /jgs. 14511.