Unrecognized Delirium is Prevalent among Older Patients Admitted to General Medical Wards and Lead to Higher Mortality Rate
Sutisa Ruangratsamee RN, APN*, Jintana Assanasen MD*, Rungnirand Praditsuwan MD*, Varalak Srinonprasert MD*
Affiliation : * Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Delirium is a syndrome associated with high mortality that often goes undetected by healthcare providers. There
has been limited evidence regarding the consequences of under-recognition of delirium on patient outcomes. The present
study aimed to investigate the rate of under-recognized delirium and explore the effect of unrecognized delirium on patient
mortality.
Material and Method: A cohort of older patients aged 70 years or more who developed delirium during admittance to
general medical wards at Siriraj Hospital between January and March 2009 was retrospectively investigated. A diagnosis
of delirium was made by geriatricians applying DSM-IV criteria. Medical records were reviewed to identify recognition of
delirium by physicians and nurses. Factors affecting mortality were investigated using univariate and multivariate logistic
regression models.
Results : Of 110 patients who developed delirium, 57.3% of cases were identified as delirium by physicians, with only 14.5%
of cases having their delirium documented in the discharge summary. Rate of delirium recognition among nurses was 61.8%,
with a comprehensive nursing care plan developed in only 13.6% of cases. Patients with delirium that went unrecognized
by attending physicians had a mortality rate of 38.3%, compared to 15.9% for the recognized delirium group (p = 0.008).
In multivariate analysis, unrecognized delirium was identified as an independent risk factor for death with adjusted OR of
5.16 (95% CI 1.45-18.29).
Conclusion : Rate of unrecognized delirium by healthcare providers in this study was high, but comparable to previous
studies. Moreover, under-recognition of delirium was found to lead to higher mortality. Routine screening for delirium and
implementation of a proactive care plan by nurses for older patients admitted to general medical wards might be a strategy
for improving this common and preventable medical condition and for lowering delirium-related mortality rates.
Keywords : Delirium, Older patients, Unrecognized, Nursing care, Mortality rate
