Exploring the utility of ultra-brief delirium assessments in a nonintensive care geriatric population

The GEM study

James S. Powers, Tracey Doering, Sharon Gordon, Svetlana K. Eden, Ayumi Shintani, John Schnelle

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV (DSM-IV) in a geriatric postacute care (PAC) rehabilitation unit. Design: Prospective observational cohort study. Setting: Postacute geriatric hospital ward of a Veteran's Affairs hospital. Participants: Consecutively admitted patients between 50 and 100 years old for inpatient postacute medical care. Measurements: Two teams, blinded to one another's evaluations, performed daily delirium assessments using either the Confusion Assessment Method for the intensive care unit (CAM-ICU) or clinical assessment based on DSM-IV. Results: There were 61 patients enrolled (median 73 years old, range: 52-94), who underwent 521 paired observations. Delirium was detected in 18 patients (29.5%) by one of the two screening methods over the course of the study, most of whom (14 patients, 23%) were delirious on the first day of enrollment. Delirium was identified by the CAM-ICU on 12.6% of the observations and by the clinical assessment on 6% of the observations (κ = 0.25, 95% confidence interval [CI]: 0.09, 0.40). Examination of disagreement between the 2 evaluations revealed that patients with dementia (κ = 0.11, 95% CI: -0.14, 0.27) had 10.7 times higher odds (95% CI: [3.1, 36.8], p value < .001) of having discordance than patients without dementia. Conclusions: Different delirium assessments may disagree depending on the study population. Dementia patients are especially challenging to evaluate for delirium.

Original languageEnglish (US)
Pages (from-to)1051-1055
Number of pages5
JournalGerontologist
Volume53
Issue number6
DOIs
StatePublished - Dec 1 2013

Fingerprint

Delirium
Geriatrics
Subacute Care
Population
Dementia
Confusion
Confidence Intervals
Intensive Care Units
Veterans Hospitals
Observational Studies
Inpatients
Cohort Studies
Rehabilitation

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology
  • Gerontology
  • Medicine(all)

Cite this

Powers, J. S., Doering, T., Gordon, S., Eden, S. K., Shintani, A., & Schnelle, J. (2013). Exploring the utility of ultra-brief delirium assessments in a nonintensive care geriatric population: The GEM study. Gerontologist, 53(6), 1051-1055. https://doi.org/10.1093/geront/gns161

Exploring the utility of ultra-brief delirium assessments in a nonintensive care geriatric population : The GEM study. / Powers, James S.; Doering, Tracey; Gordon, Sharon; Eden, Svetlana K.; Shintani, Ayumi; Schnelle, John.

In: Gerontologist, Vol. 53, No. 6, 01.12.2013, p. 1051-1055.

Research output: Contribution to journalArticle

Powers, JS, Doering, T, Gordon, S, Eden, SK, Shintani, A & Schnelle, J 2013, 'Exploring the utility of ultra-brief delirium assessments in a nonintensive care geriatric population: The GEM study', Gerontologist, vol. 53, no. 6, pp. 1051-1055. https://doi.org/10.1093/geront/gns161
Powers, James S. ; Doering, Tracey ; Gordon, Sharon ; Eden, Svetlana K. ; Shintani, Ayumi ; Schnelle, John. / Exploring the utility of ultra-brief delirium assessments in a nonintensive care geriatric population : The GEM study. In: Gerontologist. 2013 ; Vol. 53, No. 6. pp. 1051-1055.
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