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Area: Delirium


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.


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


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


purpose was to assess the prevalence of delirium among geriatric

patients with hip fractures, and to examine the influence of delirium

on rehabilitation outcomes.


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.


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



The functional recovery of patients with delirium is

slower. Therefore, it is important to adjust therapeutic approaches to

these patients.


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.



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.


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.


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.


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.


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


The ageing population has clinical issues including

psychiatric disorders. The psychomotor agitation is an heterogeneous

and common situation at the psychiatric emergency.


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.


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.


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.


The effect of Ramelteon on delirium and other circadian rhythm

disturbances. A systematic review

H.W. Lans


, A. De Jonghe


, L.E. Boom


, B.C. vanMunster


, S.B. Diraoui



S.E. de Rooij




Tergooi Hospitals, Hilversum,


Academic Medical Center,



Gelre Hospitals, Apeldoorn,


University Medical Center

Groningen, Groningen, The Netherlands


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



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.


The search ultimately yielded 18 studies that met the

inclusion criteria.


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