Resources and Sites

Online Resources

Delirium in Older Adults: A Guide for Seniors and their families – Canadian Coalition of Senior’s Mental Health

Tools for Health Care Providers: The Assessment & Treatment of Delirium in Older Adults – Canadian Coalition of Senior’s Mental Health

Recognizing Delirium, Dementia and Depression  - Developed by theTorontoRegion Best Practice in LTC Initiative (January 2007)

Delirium in the Older Person – Vancouver Island Health Authority

Knowledge Depot- Registered Nurses’ Association of Ontario

 The Hospital Elder Life Program (HELP) 

ICU Delirium For Patients and Families - ICU Delirium and Cognitive Impairment Study Group

ICU Delirium For Practitioners - ICU Delirium and Cognitive Impairment Study Group

ICU Delirium For Practitioners - Society for Critical Care Medicine, ICU Liberation

Delirium Awareness Video – Creative Connection

 

Research and Suggested Readings

Freter, Susan, et al. Translating Delirium Prevention Strategies for Elderly Adults with Hip Fracture into Routine Clinical Care: A Pragmatic Clinical Trial. Journal of the American Geriatrics Society (2016).

The authors compare adherence and effectiveness of delirium-friendly preprinted postoperative orders (PPOs) for patients with hip fractures. They found that it is possible to introduce delirium friendly PPOs into routine care, and PPOs can result in a significant reduction in postoperative delirium.

Freter, Susan, et al. Prevalence and characteristics of pre-operative delirium in hip fracture patients. Gerontology 62.4 (2016): 396-400.

This study documents prevalence and risk factors for pre-operative delirium in hip fracture patients, and compares risk factor profiles and outcomes between pre- and post-operative delirium.

Freter, Susan, et al. Risk of pre-and post-operative delirium and the delirium elderly at risk (DEAR) tool in hip fracture patients. Canadian Geriatrics Journal 18.4 (2015): 212.

This study investigates the ability of the DEAR (Delirium Elderly At Risk) instrument to identify patients at high risk of pre-operative delirium, and it’s performance in a post-operative sample. The article concludes that the DEAR is a simple delirium risk factor screening tool that can be used to identify at risk patients which may allow for targeted prevention strategies.

Juliana Barr, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical care medicine 41.1 (2013): 263-306.

These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.

Martin B, Buth KJ, Arora RC, Baskett, RJF. Delirium: A Cause for Concern beyond the Immediate Postoperative Period. Ann Thorac Surg (2012) 93:1114 –20.

This recent Canadian study found that patients who developed delirium were more likely to be older and have a greater burden of co-morbid illnesses. Researchers found an association between delirium and adverse outcomes after cardiac surgery including increased long-term risk of death and stroke in advanced age. Lends support to the hypothesis that the development of perioperative delirium may be a sign of a fragile brain.

Nie H, Zhao B, Zhang Y, Jiang Y, Yang Y. Pain and cognitive dysfunction are the risk factors of delirium in elderly hip fracture Chinese patients. Archives of Gerontology and Geriatrics (2012), 54  e172–e174.

A Chinese study found that risk factors for the development of delirium among elder hip fracture patients include pain intensity and cognitive impairment.  This study suggests that prevention and management of delirium requires pain management pre and post operatively.

Marchington, KL, Carrier L, Lawlor PG. Delirium masquerading as depression. Palliative and Supportive Care (2012), 10, 59–62.

A case report highlighting the major challenges associated with making the diagnosis of delirium in a 63 year old female patient with a complex medical history including depression.

Holly C, Cantwell ER, Jadotte Y. Acute Delirium: Differentiation and Care. Crit Care Nurs Clin N Am 24 (2012) 131–147.

A report on the nature of delirium including risk factors, types, prevention and treatment. Suggests that health professionals have difficulty recognizing and treating delirium given the fluctuating nature of the condition and emphasizes the importance of recognition and prevention.

Rudolph JL, Marcantonio ER. Review articles: postoperative delirium: acute change with long-term implications. Anesth Analg. 2011; 112(5):1202-11.
A guide to assess delirium risk preoperatively, and to prevent, diagnose, and treat this common and morbid condition.

Eeles E, Rockwood K. What a general internist should know about delirium in older adults. Canadian Journal of General Internal Medicine. 2010; 5:110-113.
This article reviews what delirium is, how to recognize it, what a general internist can do for patients with delirium.

Caplan, JP, Rabinowitz, T. An Approach to the Patient with cognitive Impairment: Delirium and Dementia. Med Clin N Am 94 (2010) 1103–1116.

The authors provide a broad outline of the diagnostic criteria of delirium and dementia, review the current understanding of their pathogenesis and discuss useful diagnostic and therapeutic techniques. This paper highlights the need for a careful approach to identifying somatic issues that may be causing or exacerbating cognitive and behavioral issues to avoid misdiagnoses.

Andrew MK, Bhat R, Clarke B, Freter SH, Rockwood MR, Rockwood K. Inter-rater reliability of the DRS-R-98 in detecting delirium in frail elderly patients. Age Ageing. 2009 Mar;38(2):241-4.

An assessment of the IRR of DRS-R-98, a revised version of the Delirium Rating Scale (DRS) that allows for assessment of both delirium diagnosis and severity.

Eeles E, Rockwood K. Delirium in the Long-Term Care Setting: Clinical and Research Challenges. Journal of the American Medical Directors Association. 2008; 9:157-161.

An updated review of delirium in long term care settings and the border between dementia and delirium.

Bhat R, Rockwood, K. Delirium as a disorder of consciousness. J Neurol Neurosurg Psychiatry. 2007; 78(11): 1167–1170.

The authors argue that delirium can be recognized through evaluating arousal, attention and temporal orientation and suggest that a more multidimensional approach can be validated by testing whether it leads to better delirium identification, accounts for the characteristic clinical disturbances, explains why delirium is common in the extreme age groups and why in later life its boundaries often blend with dementia.

Andrew M, Freter S, Rockwood K. Prevalence and outcomes of delirium in community and non-acute care setting in people without dementia: a report from the Canadian Study of Health and Aging. BMC Med. 2006; 4:15.

A secondary analysis of the Canadian Study of Health and Aging that examines delirium prevalence and outcomes of a large sample of older Canadians living outside of acute care.

Freter S, George J, Dunbar M, Morrison M, MacKnight C, Rockwood K. Prediction of delirium in fractured neck or femur as part of routine pre-operative nursing care. Age and ageing. 2005;34:387-388.

The aim of this study was to assess prospectively the value of routinely collected nursing information combined as a simple risk score in predicting the occurrence of delirium in fractured neck of femur patients and thus potentially help in prevention and treatment of delirium.

Andrew M, Freter S, Rockwood K. Incomplete functional recovery after delirium in elderly people: a prospective cohort study. BMC geriatrics. 2005;5:5

Identifying factors associated with short-term (by discharge) and long-term (by 6 month) incomplete recovery of function following delirium.

Bhat R, Rockwood K. Inter-Rater Reliability of Delirium Rating Scales. Neuroepidemiology. 2005;25:48-52.

An analysis of the inter-reliability data of published rating scales for delirium using a standard questionnaire to evaluate if the inter-rater reliability was assessed rigorously.

Freter S, Dunbar M, MacLeod H, Morrison M, MacKnight C, Rockwood K. Predicting post-operative delirium in elective orthopedic patients: the Delirium Elderly At-Risk (DEAR) instrument. Age and ageing. 2005;34:169-184.

The authors assessed the feasibility of incorporating the DEAR into routine nursing care of elective orthopaedic patients and evaluated its usefulness in predicting POD.

Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry (2004) Jan-Feb;12 (1):7-21.

A comprehensive review of delirium in elderly patients. The author suggests that preventative and systematic detection and treatment programs are beneficial for elderly surgical patients and should be implemented into acute-care hospitals.

Rockwood K, Lindesay J. Delirium and Dying. Int Psychogeriatr. 2002 Sep;14(3):235-8.

An editorial on delirium, diagnoses and palliative care.

Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001; 49(5):516-22.

A randomized trial in an orthopedic surgery service at an academic hospital to determine whether proactive geriatrics consultation can reduce delirium after hip fracture.

Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM Jr. The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in hospitalized older patients. J Am Geriatr Soc 2000; 48:1697–1706.

A description of the Hospital Elder Life Program, a new model of care designed to prevent functional and cognitive decline of older persons during hospitalization.

Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr. Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients. N Engl J Med 1999; 340:669-676.

Since in hospitalized older patients delirium is associated with poor outcomes, the authors evaluated the effectiveness of a multicomponent strategy for the prevention of delirium.

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: 941-8.

The development of a new standardized confusion assessment method (CAM) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk settings.