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Area: Delirium
P-286
Prevalence of delirium in geriatric rehabilitation in Israel and its
influence on rehabilitation outcomes in patients with hip fractures
N. Heyman, N. Frances, R. Shahory, I. Seleznev, M. Ben Natan.
1
Department of Geriatrics, Shoham Medical Center, Pardes Hana, Israel,
affiliated with the Rappaport Faculty of Medicine, Technion-Israel
Institute of Technology; Pat Matthews Academic School of Nursing
Introduction:
Hip fractures are among the most serious injuries in
elderly populations. Potential complications include the development
of delirium syndrome during post-fracture rehabilitation. Delirium
syndrome may be characterized by insufficient diagnosis and lack of
adequate documentation, hampering quality of care and patient
outcomes. Previous studies have not provided definitive evidence on
the influence of delirium on rehabilitation outcomes. This study
’
s
purpose was to assess the prevalence of delirium among geriatric
patients with hip fractures, and to examine the influence of delirium
on rehabilitation outcomes.
Method:
A prospective study was conducted among 95 hip fracture
patients admitted to an orthopedic geriatric rehabilitation ward.
At admission, the following data were gathered: Sociodemographic
data, pre-fracture ADL, FIM, MMSE, comorbidities, and medication.
Deliriumwas assessed using the CAM. The severity of delirium among
patients with a positive score on the CAMwas assessed using the DRS-
R-98. Rehabilitation outcomes were evaluated by comparing FIM and
ADL at admission and discharge.
Results:
The prevalence of delirium among patients was 30%. A
significant difference was found between patients who developed
delirium and those who did not. Patients who developed delirium had
lower ADL levels at admission, more significant renal failure, lower
levels of FIM, lower MMSE scores, and were more likely to be Jewish
than Arab. Furthermore, FIM at discharge and delta FIM were lower
among patients who developed delirium than among those who did
not.
Conclusions:
The functional recovery of patients with delirium is
slower. Therefore, it is important to adjust therapeutic approaches to
these patients.
P-287
Improved quality of care of older patients experiencing a delirium
within the acute hospital setting: a quality improvement project
J. Chapman, J. Anderson, S. Goldberg.
NUH and KCL
Introduction:
Delirium is a clinical syndrome characterized by
disturbed consciousness, cognitive function or perception, which has
an acute onset and fluctuating course (NICE, 2010). It has a high
incidence in frail older people (Ferguson, Miller et al, 2008). It affects
between 6 and 56% of older hospital patients and is associated with
adverse outcomes. Despite this, delirium goes under-recognised with
many cases remaining undiagnosed (Fong, Tulebaev & Inouye, 2009).
Nurses have a critical role in recognising the signs of delirium, working
closely with junior doctors to care for these patients. However, poor
communication and understanding surrounding delirium and its
management can result in suboptimal care.
Methods:
The aim of this project is to improve quality of care of older
patients experiencing a delirium within the acute hospital setting
by improving knowledge and communication around delirium
between the multidisciplinary team. The model for improvement
(NHS Institute, 2008) in association with Plan, Do, Study, Act (PDSA)
cycles will be used to analyse whether key educational interventions
and implementation strategies have been effective in improving care
for these patients
’
. PDSA 1: evaluation of small group education
sessions using pre/post teaching knowledge and confidence ques-
tionnaires. PDSA 2: an audit of communication around delirium in
nursing andmedical notes before and after education. PDSA 3: an audit
of multidisciplinary (MDT) boardround communication before and
after education.
Results:
A small improvement in practitioners
’
knowledgewas noticed
with a clear increase in staff confidence was demonstrated post
teaching. This resulted in improved communication at MDT boar-
dround and better documentation of delirium diagnosis and manage-
ment in patient records.
Conclusion:
This project improved quality of care for older patients
experiencing a delirium. Greater knowledge, increased confidence
and improved communication results in earlier detection and better
management of delirium in frail older people.
P-288
Agitation in the elderly in the psychiatric emergency department
F. Henriques, S. Domingues, I. Amado, M. Cotter, H. Figueiredo,
L. Delgado.
Centro Hospitalar Médio Tejo (CHMT), Tomar, Portugal
Introduction:
The ageing population has clinical issues including
psychiatric disorders. The psychomotor agitation is an heterogeneous
and common situation at the psychiatric emergency.
Methods:
It is a retrospective study madewith 252 cases with patients
>65 years old. We worked 66 cases with psychomotor agitation that
occurred in a psychiatric emergency department during the first
quarter of 2016. The data was analyzed using several tools (Excel,
SPSS). For each process we have gathered 75 variables, 44 of those,
where selected to answer meet our goals.
Results:
The majority of the sample were female, age average 78.2,
78.8% lived in their own house, and 57.6% have arrived by other
emergency specialties. Half of this cases were known to the psychiatry
team. The previous psychiatry diagnosis most seen was dementia
followed by depression. The main psychopathology changes were
orientation, sleepiness and memory. In the majority of this cases
we had organic origin for the agitation (54.3%), then demencial,
psychiatric, organic + psychiatric. After being reviewed most cases
were referred to general practitioners. 75.8% of the patients had
several not psychiatric comorbilities. Prior to the emergency admis-
sion 43.9% took benzodiazepines that have reduced after afterwards,
an increased of antidemential prescription as antidepressive medicine
was noted. Mood stabilizers were almost never used. Despite the risk
of usage of antipsychotics at old age thosewerewidely prescribed from
41% before the agitation and 83.3% after.
Conclusions:
The main etiology of agitation at old agewas organic still
this study were at the psychiatric emergency department. Although
the risk, the antipsychotics werewidely used to contain this situations.
P-289
The effect of Ramelteon on delirium and other circadian rhythm
disturbances. A systematic review
H.W. Lans
1
, A. De Jonghe
1
, L.E. Boom
2
, B.C. vanMunster
3,4
, S.B. Diraoui
1
,
S.E. de Rooij
4
.
1
Tergooi Hospitals, Hilversum,
2
Academic Medical Center,
Amsterdam,
3
Gelre Hospitals, Apeldoorn,
4
University Medical Center
Groningen, Groningen, The Netherlands
Introduction:
Disturbances of the circadian rhythm occur in a variety
of disorders, e.g. in primary insomnia and in delirium. Recently,
Ramelteon was approved by the US Food and Drug Administration
for treatment of insomia. Ramelteon is a melatonin receptor agonist
with a higher affinity to the MT1 and MT2 melatonin receptors
and has a longer half-life than melatonin. The objective of this review
is to evaluate the effect of Ramelteon in all circadian rhythm
disturbances.
Methods:
We conducted a systematic search on December 2015
in Pubmed, Embase and Web of Science to identify randomized
controlled trials (RCTs) in which Ramelteon is compared to other
interventions or placebo with a circadian rhythm related outcome.
Results:
The search ultimately yielded 18 studies that met the
inclusion criteria.
Discussion:
12 of the 18 included RCTs showed a positive result of
Ramelteon treatment on the circadian rhythm related outcome,
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
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