European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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including one RCT that studied the preventive effect of Ramelteon in
patients with delirium [Hatta 2014]. Recently, there have been three
studies on the prevention of delirium with melatonin Of these, two
showed a decrease in incidence of delirium [Sultan 2010, Al Aama
2010, de Jonghe 2014]. The need for an effective and safe treatment
for delirium is substantial as many patients suffer from delirium each
year and it has severe long-term consequences.
Conclusion: The results of the RCTs in our review suggest that
Ramelteon has a positive effect on circadian rhythm disturbances as
seen in patients with insomnia and delirium.
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Impact of delirium in geriatric patients admitted to an acute heart
failure unit: preliminary data
P. Mendonça 1, A. Félix-Oliveira1, G. Sarmento1, I. Araujo1, F. Marques1,
C. Fonseca1. 1Internal Medicine Department of Hospital São Francisco
Xavier, Lisbon, Portugal
Objectives: Geriatric syndromes are frequent and underestimated in
heart failure (HF). Delirium was pointed as a determinant factor in
quality of life. The aim of the study was to estimate the prevalence of
delirium, characterize those patients and their length of stay.
Methods: Prospective study of consecutive HF patients, aged >65 y,
admitted to HF Unit during 9 months. All were submitted to a Mini
Mental State (MMS) questionnaire and delirium events were regis-
tered and treated. A detailed analysis of the patients who presented
delirium was made.
Results: 64 patients were admitted. HF etiology was 33,3%
Hipertensive; 33,3% valvular and 22.2% ischemic and 44,4% had HF
with reduced ejection fraction. Nine (14%) had delirium. 66.6%
were males, aged 79 ± 1.4, 55.6% presented a mRankin scale of 1,
11.1% of 2 and 33.3% of 3. None of the patients was previously
diagnosedwith dementia or depressive syndrome, although 44.4% had
cognitive impairment on the MMS at admission. Infectionwas present
in 55.5% of the patients. Psychopharms were used in 88.8% (44.4%
quetiapine, 33.3% haloperidol, 11.1% benzodiazepines). The length of
stay was 14.8 ± 4.32, longer than the 8.48 ± 0.5 days of patients without
delirium.
Conclusions: Cognitive impairment was frequent and underdiag-
nosed in this old HF population. Delirium occurred in a significant
number of patients who required urgent treatment and doubled the
length of stay. Geriatric syndromes have to be screened at admission
and precociously treated.
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Operationalising routine delirium screening with the 4AT for older
patients attending an AMAU
R. Moola 1, A. Fallon1, R. Briggs1, T. Coughlan1, D. O’Neill1, R. Collins1,
J. Armstrong 1, S.P. Kennelly 1. 1Tallaght Hospital, Dublin, Ireland
Objectives: Delirium is frequently associated with adverse outcomes,
including prolonged inpatient stay, increased mortality, functional
decline and increased need for residential care. Despite these
outcomes recurrent studies have demonstrated challenges to delirium
identification, thus limiting essential early intervention. The objective
of this study was to incorporate and evaluate delirium screening on
admission to an Acute Medical Assessment Unit (AMAU) and review
its documentation and follow up on discharge.
Methods: Consecutive patients aged ≥65 presenting to the AMAU
were prospectively screened from 15/2/16 to 08/05/16. Delirium
screening was performed using the 4AT. The 4AT was integrated into
the Symphony® electronic patient record, as a necessary step in
the admission/discharge of all older patients. Discharge letters were
evaluated in those scoring either 1 –3 or ≥ 4 on the 4AT to assess
documentation and follow up of acute definite/possible delirium.
Results: 211 people aged ≥65 attended the AMAU during the allocated
time. 19/211 (9%) scored ≥4 indicating likely delirium, 34/211 (16.1%)
scored 1–3 suggesting possible delirium or cognitive impairment. Two
patients in each category remained in hospital at the time of data
collection and were omitted. 52.9% (≥4) and 18.8% (1–3) had known
premorbid dementia. New diagnoses of dementia were made in 6.1%
(3/49) all scoring 1–3. Deliriumwas documented on discharge in 47.1%
(8/17) in ≥4 and 3.1% (1/32) in 1– 3 and its management specified
in 62.5% (5/8) in ≥4 and 100% (1/1) in 1–3. On discharge, formal
cognitive assessments were documented in 6.3% (2/32) of 1–3,
although 34.4% (11/32) of this group and 29.4% (5/17) ≥4 were
referred for further evaluation of cognition on discharge.
Conclusions: Incorporating the 4AT as part of the AMAU admission
pathway is feasible, and useful to support identification of delirium in
older patients, thus allowing for timely management. Future strategies
will focus on improving discharge documentation.
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Identifying and managing delirium on admission
B. Musaddaq, P. Bakshi, H. Roseman, J. Pleming, S. Saber, A. Wu,
R. Mizoguchi. Department of Geriatrics, Royal Free Hospital,
United Kingdom
Introduction: 10–31% of elderly patients are delirious on admission
with 67% of them not being diagnosed. This leads to prolonged
hospital stay, increased complications and costs. The National Institute
of Clinical Excellence (NICE) has developed guidelines to assess
risk factors, indicators, interventions to prevent delirium and to aid
diagnosis using the short CAM (Confusion Assessment Method). The
aim was to ascertain whether patients over 65 years of age are being
screened for delirium and managed appropriately on admission.
Method: A retrospective audit of 2 weeks period was carried out
looking at admissions of medical patients over 65 years old in order to
confirm whether patients were assessed for and diagnosed appropri-
ately with delirium according to the NICE guidelines.
Results: 92 out of 113 responses fulfilled the inclusion criteria. 62% of
patients had an AMTS (Abbreviated Mental Test Score) recorded on
admission and 20% had a completed short CAM score. 38% of patients
were not diagnosed with delirium despite fulfilling criteria. Risk
factors and precipitants such as polypharmacy, nutrition, sleep and
sensory impairment were poorly assessed. Infection was elicited
the best.
Conclusion: This audit shows that delirium is poorly diagnosed and
screening tools are not being routinely used. Risk factors, indicators
and precipitants of delirium are not being assessed enough; hence the
diagnosis is often missed. We have implemented a delirium pathway
and improved staff training to raise awareness of the screening and
diagnostic process. The next stage would be to re-audit to see if these
interventions have been effective.
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Delirium recognition in older people using a validated assessment
tool (Confusion Assessment Method, CAM) improves rates of
diagnosis, communication and the overall quality of care
O. Akintade, G. Khurana, M. Arora. Medicine for Older People,
Peterborough City Hospital, United Kingdom
Introduction: Delirium is a serious condition that remains poorly
recognised and managed despite its high prevalence in older people.
NICE (National Institute for Health & Care Excellence) recommends the
use of CAM to improve formal identification of delirium.
Methods: We completed an audit cycle based on recommendations
in NICE guidance 103 and quality standard 63. An initial audit
reviewed the clinical notes of 100 patients with indicators of delirium
presenting to our hospital. These looked at the proportion of patients
that had formal identification, documentation on triggers and
treatment, provision of information to patients and or relatives and
communication of diagnosis to the General Practitioner on discharge.
Following on this, a pilot study was undertaken on 50 patients using
CAM to identify delirium. These patients were assessed for the same
parameters on the initial audit.
Results: The identification of delirium improved from 4% to 98% on
using CAM. Clinical record of underlying triggers and treatment for
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S106