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delirium improved significantly. Recorded sharing of information on
deliriumdiagnosis with patients/relatives and the General Practitioner
improved from nil and 30% respectively in the initial audit to 98%
and 78% respectively in the pilot study.
Conclusion:
Formal identification of delirium using validated assess-
ment tools like CAM, 4AT (Assessment Test) and SQiD (Single Question
in Delirium) significantly improves diagnosis, identification and
treatment of underlying causes, provision of information to patients,
relatives and communication amongst health care professionals.
Promoting their use will improve the quality of care for older people
with delirium. Disclosure No significant relationships
P-294
Acute confusional state syndrome in hospitalized patients
suffering from hip fracture
M.I. Porras-Guerra
1
, T. Porras-Guerra
2
, M.A. De La Torre-Alonso
3
,
C.E. Benitez-González
1
, M.N. Gómez-Gónzalez
1
.
1
Servicio de Geriatría.
CAULE,
2
I.E.S. Tomás Bretón. Salamanca,
3
Servicio de Psiquiatria. CAULE
Background:
Delirium is a frequent complication in hospitalized
patients.
Objective:
Determining characteristic of admitted patients suffering
from hip fracture and delirium during their hospitalized period.
Material and methods:
Observational, longitudinal and retrospective
study of admitted patients medical records that suffer from hip
fracture and have delirium during hospitalization period. Variables:
sex, age, hospitalized period, domicile, type of delirium, beginning and
duration, associated pathologies and consumed medicines. Tracing:
60 days. Statistical treatment: SPPSv.15.
Results:
n = 66. Males: 27,3%. Female: 72,7%. Average age 85,1 years. No
sex differences. Average stay: 14,1 days. Males 20,5 days. Female: 12
days. Double stay for male. Domicile: Family 71,2%, Alone 6,1%,
Residence 22,7%. Delirium: Hyperactive: 66,1%. Hypoactive: 16,7%.
Mixed: 16,7%. Beginning of delirium: 1st day: 24,2%, 2nd day: 16,7%,
3rd day: 13,6%, 4th day: 10,6%, 5th day: 1,5%, 6th day: 13,6%, 6th day
more than: 7,5%. Delirium duration: Average duration: 2,4 days. 40,9%
1 day. 25,7% 2 days. 10,6% 3 days. 3,6% 4 days, 5 or more days 9%.
Associated pathologies: Average pathologies: 3,1. Hypertension: 66.7%,
heart disease: 34,8%, neurological disease: 34,8%, diabetes: 28,8%,
dyslipidemia: 25,7%, psychiatric disease: 19,7%. respiratory disease
10,6%, renal failure: 9,1%. Average consumption of drugs: 4,8.
Treatment: Surgery:90,9%. Conservative 9,1%.
Conclusion:
The most common type is the hyperactive delirium lasts
an average of 2,4 days and is presented in the first 24 hours. The
comorbidity associated with delirium was hypertension, heart and
neurological disease. The patient
“
type
”
with hip fracturewho suffered
delirium during hospitalization is a woman of 85 years with heart and
neurological disease, which has an overactive delirium in the first 24
hours, lives in the family home, taking an average of 4 drugs, receives
surgical treatment and remains hospitalized about 14 days.
P-295
Implementing a delirium prevention programme can reduce falls
in hospital geriatric medicine wards
A. Solomonsz
1
, L. Charalambous
1
, R. Taylor
1
, E. Blackshaw
1
, A. Ali
1
,
R. Morris
1
, R. Moorchilot
1
, M. Poon
1
, A. Blundell
1
, R. Harwood
1
,
T. Masud
1
.
1
Nottingham University Hospitals NHS Trust, United Kingdom
Background:
Delirium is a common problem in older hospital
inpatients and is associated with morbidity including an increased
risk of falls. The aim of this analysis was to determine if implementing
a delirium prevention service improvement intervention reduced falls
in geriatric medicine wards.
Methods:
A delirium prevention package was implemented over
a three month period on two 28 bedded female geriatric wards at a
large teaching hospital. The intervention included specialised training
for staff on assessment and management of cognitive impairment,
mobility, pain, nutrition, sensory impairment, sleep disturbance,
medications, dehydration, hypoxia and infection in addition to
developing new ward systems to increase delirium awareness. The
established hospital adverse incident reporting system (Datix) was
used to compare the falls per month in the six month periods before
and after implementing the intervention.
Results:
The mean fall rate before the intervention was 4.9/month
(95%CI = 4.5
–
5.7) which fell to 2.5/month (95%CI = 1.5
–
3.4), the mean
difference being 2.4/month (95%CI = 1.2
–
3.7) [p = 0.001]. There was
no significant change in mean length of stay with the intervention
[pre-intervention 13.3 days (95%CI = 12.4
–
14.1) vs post-intervention
14.8 days (95%CI = 13.5
–
16.0), NS].
Conclusion:
Delirium and falls share many of the same risk factors
and the former is an independent risk factor for the latter. These data
show that better prevention and earlier diagnosis and treatment for
delirium reduced falls by almost a half in geriatric medicine wards,
although length of stay was not changed.
P-296
An embedded research project improves recognition of delirium in
older hospital inpatients
C. Welch, T.A. Jackson.
University of Birmingham
Background:
There is evidence that research activity can improve
patient outcomes in hospital [1]. Delirium is a severe acute
neuropsychiatric syndrome affecting mainly older people in hospital.
Delirium affects 15
–
25% of acute admissions to hospitals, yet is under-
recognised. Our aimwas to assess if an embedded research project on
an acute admissions unit would improve delirium recognition.
Methods:
125 patients admitted to hospital with a diagnosis of DSM-
IV deliriumwere recruited to a prospective cohort study over a period
of 21 months. Delirium was diagnosed independently after the initial
admission assessment. We recorded whether the delirium diagnosis
was (1) recognised by the admitting assessment and (2) commu-
nicated in the discharge letter. Differences between these proportions
were tested.
Results:
Delirium recognition by the admitting team improved over
the course of the study. More delirium cases were recognised in the
second half than in the first half of recruitment (47.6% vs 71%, p = 0.01).
A similar trend was seen through analysis of quartiles (41.9%, 51.6%,
74.2%, 68.8%, p = 0.034). There was no difference between the
recording of delirium as a diagnosis in discharge summaries (41.3%
vs 56.5%, p = 0.11). No other delirium recognition improvement
projects took place during project recruitment.
Conclusion:
Embedding a research project on an acute admissions
unit improved recognition of delirium on admission but not at
discharge. This suggests clinical research has wider systems benefits
on patients as improved recognition of delirium can improve patient
outcomes. This improvement may be due to the Hawthorn Effect.
Reference
1. Ozdemir BA, K.A., Sinha S, Poloniecki JD, Hinchliffe RJ, Thompson
MM, Gower JD, Boaz A, Holt PJ. Research activity and the associa-
tion with mortality.
PLoS One
, 2015. 10(2).
Area: Ethics and end of life care
P-297
The importance of the integration of palliative care on geriatrics
wards at general hospitals
B. Svirsky, E. Kaykov.
Western Galilee Medical Center, affiliated to Faculty
of Medicine in the Galilee, Bar-Ilan University. Israel
The Geriatrics ward of our general hospital house elderly patients
with acute illnesses and complex geriatric histories, requiring
careful evaluation and treatment. Many of these patients suffer from
advanced dementia and advanced-stage chronic illnesses such as
heart failure, respiratory failure or chronic system failure
–
all of which
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S107