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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.


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.


Impact of delirium in geriatric patients admitted to an acute heart

failure unit: preliminary data

P. Mendonça


, A. Félix-Oliveira


, G. Sarmento


, I. Araujo


, F. Marques



C. Fonseca




Internal Medicine Department of Hospital São Francisco

Xavier, Lisbon, Portugal


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.


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.


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



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.


Operationalising routine delirium screening with the 4AT for older

patients attending an AMAU

R. Moola


, A. Fallon


, R. Briggs


, T. Coughlan


, D. O



, R. Collins



J. Armstrong


, S.P. Kennelly




Tallaght Hospital, Dublin, Ireland


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.


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.


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


although 34.4% (11/32) of this group and 29.4% (5/17)

4 were

referred for further evaluation of cognition on discharge.


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.


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



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.


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.


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.


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.


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


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.


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.


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