Delirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population sample.

This study analyzed routinely collected national clinical registry data for all people in Scotland aged 50 years and over presenting with a hip fracture between 1 July 2019 and 31 December 2021. Delirium was assessed prospectively by clinicians as part of routine care using the 4AT, a validated two-minute assessment tool. Associations of 4AT score with mortality and return home within 30 days were analyzed using logistic regression models, adjusted for confounders.

Of 18,040 patients (mean age 80 years (SD 10); 70% female (n = 12,594)), 16,476 (91%) had a 4AT assessment on presentation and of these, 3,386 (21%) had a score ≥ 4, suggestive of delirium. Patients with delirium were older, more likely residing in care homes, and had higher American Society of Anesthesiologists grades (all p < 0.001). Delirium was independently associated with a twofold increased risk of inpatient mortality (adjusted odds ratio (aOR) 2.26 (95% CI 1.79 to 2.84)) and one-year mortality (aOR 2.05 (95% CI 1.83 to 2.29)), and a lower likelihood of returning home within 30 days (aOR 0.27 (95% CI 0.24 to 0.30)).

Delirium affects around 20% of patients presenting with a hip fracture, and is associated with important adverse outcomes. Integrating delirium assessment into the initial clinical assessment of hip fracture patients is feasible at national scale, and should be considered as part of care for all hip fracture patients.

Rising Emergency Department (ED) demand strains resources to assess and manage frail older adults. Allied health supports comprehensive care, disposition planning and patient safety in the ED but often intervenes late. This study investigated factors affecting allied health referrals and co-designed an early allied health frailty service.

An explanatory sequential mixed-methods approach was used. Patient journey mapping of low acuity older ED patients was followed by stakeholder focus groups.

From triage, 20 older ED patients waited a mean of 110 minutes (SD 83 minutes) for doctor assessment, 123 minutes (SD 116 minutes) for an ED bed and 355 minutes (SD 297 minutes) for allied health assessment with a mean ED length of stay (LOS) of 685 minutes (SD 444 minutes). Qualitative analysis of focus group discussions identified perceived benefits of an early allied health service including shorter LOS, earlier disposition planning, increased staff confidence and streamlined decision making. Perceived barriers were lack of space, competing assessments with doctors and incomplete investigations. Perceived solutions were refining the inclusion criteria and staff education.

Allied health assessment occurred six hours post presentation, outside national targets. Opportunities and barriers identified supported the development of an earlier allied health frailty service.

Delirium is an acute fluctuating impairment of attention and awareness, common in acute ischemic stroke (AIS). This study aimed to evaluate the prognostic significance of delirium for neurological function at 3 months post-stroke, and develop a predictive model integrating delirium and biomarkers to enhance prognostic accuracy.

We conducted a prospective cohort study of patients admitted to the stroke unit (n=722). All patients were screened for daily delirium during clinical care. Plasma biomarkers were measured within 24 hours after admission. The main outcomes were evaluated with the 3-months modified Rankin Scale (mRS).

Delirium developed in 10.2% of patients during the acute phase of stroke. Patients with post-stroke delirium (PSD) was significantly older (median age 74 vs 68 years, P<0.001), more likely to have pre-stroke cognitive impairment (14.9% vs 4.8%, P=0.001), a higher prevalence of cardiovascular history (35.1% vs 16.2%, P<0.001). PSD was also associated with higher scores of NIHSS (14.3 vs 9.1, P<0.001) and greater scores of mRS (3.0 vs 1.5, P<0.001) at admission. PSD patients showed worse outcomes, with elevated NIHSS and mRS scores at discharge and 3-month follow-up, as well as higher mortality rates (5.4% vs 1.4%, P=0.025). Biomarker analysis revealed increased plasma levels of inflammatory (white blood cells, neutrophils, C-reactive protein) and coagulation biomarkers (fibrinogen, D-dimer) in PSD patients, particularly those with poorer outcomes (P<0.01). Our model, which incorporated delirium and biomarkers of inflammation and coagulation dysfunction, demonstrated strong predictive accuracy for adverse outcomes at 3 months with an AUC of 0.779 (95% CI=0.736-0.822), with clinical utility confirmed by decision curve analysis.

PSD is a strong independent predictor of poor 3-month outcomes in AIS, including higher mortality and disability. Our findings highlight the critical role of inflammation and coagulation dysfunction in the pathogenesis of PSD. Furthermore, we present the clinical utility of a predictive model integrating delirium and relevant biomarkers to assess the risk of adverse outcomes at 3 months, suggesting potential targets for intervention.

Dysphagia is a geriatric syndrome often unrecognized or underestimated, and there is a lack of studies in a heterogeneous population in intermediate care (IC) services. This study aims to describe the prevalence of dysphagia and its association with geriatric syndromes in older patients in IC.

Prospective cohort study of patients 70 years and older admitted to an IC unit. At admission, the severity of the clinical conditions, comorbidity, delirium, frailty, sarcopenia, nutritional status, and medications were assessed. Each patient was evaluated with the 3-OZ test, and dysphagia was confirmed by a speech therapy consultation. Two multivariable logistic regression models were used to evaluate the association of dysphagia at admission with geriatric syndromes (model 1), along with the severity of illness and admission diagnosis (model 2).

A total of 455 patients were included. The prevalence of dysphagia was 10% and there was a high prevalence of mild-moderate dysphagia in patients with cognitive impairment and moderate risk of malnutrition. In the univariate analysis, an association was found between dysphagia and sarcopenia, malnutrition, and use of antipsychotics. In Model 1, higher odds of dysphagia were associated with the severity of comorbidity (Odds Ratio 6.49, 95% Confidence Interval: 2.02-20.78), and cognitive impairment (OR 0.91, 95% CI: 0.88-10.62); in Model 2, the severity of clinical conditions-NEWS2 (OR 1.61, 95% CI: 1.23-2.13) was associated with dysphagia, besides the severity of comorbidity and cognitive impairment. In a subset of 300 patients, delirium was also associated with dysphagia.

The study provides novel information on dysphagia prevalence in patients admitted to an IC unit and its association with geriatric syndromes. Additional research is needed to further define the relationship between geriatric syndromes and dysphagia, and to adequately standardize speech therapist treatments.

Falls are a source of harm, repeat emergency department visits and hospital admission for older adults. Undertaking a comprehensive geriatric screening including falls-risk is recommended in guidelines for optimal older adult emergency department care.

A pragmatic prospective cohort study was undertaken to evaluate use of further falls-risk screening in older adults in a large tertiary Australian hospital emergency department. Primary outcome measures of interest were length of stay; discharge destination; 30-day and 90-day re-presentations.

Of 651 eligible cases, 320 were randomly recruited for further screening following consent. The implementation cohort spent an average 45 m longer in the emergency department with a greater proportion admitted to the short stay unit, staying there longer than a comparison cohort. There were significantly fewer 30-day fall-related representations (2.9 %) in the implementation cohort.

Despite a small reduction in emergency department re-presentation within 30 days in the implementation cohort, hospital admission was not reduced. Further research is needed to examine any cost-benefit ratio of additional falls-risk screening and intervention in emergency departments.

Populations in Africa are ageing, hence the number of age-related fragility fractures, including hip fractures, is rising. Hip fractures are an indicator condition for older adult health provision, as they require a multifaceted pathway of care. To enable health service planning, detailed national-level understanding of current fracture service provision is needed.

The WHO Service Availability & Readiness Assessment survey was modified to evaluate fracture service availability, and readiness. All health care facilities to which a patient with a hip fracture could present in The Gambia and Zimbabwe were invited to participate between October 2021 and January 2023. A further traditional bone-setter (TBS)-specific survey assessed TBS care in The Gambia. Availability of services per 100 000 adults ≥ 18 years, and general, fracture-specific, and hip fracture-specific care readiness were determined.

All invited facilities in Zimbabwe (n = 186), 98% in The Gambia (n = 150), and 35 of 42 (83%) TBS participated in the survey. General availability of hospital facilities was low in both Zimbabwe and The Gambia and many facilities lacked regular electricity, reliable oxygen supplies, and sharp/infectious waste disposal. In The Gambia, 78.6% public hospitals and 53.8% other facility types (e.g. NGO/mission) had no doctors. Fracture care readiness: < 1 orthopaedic surgeon was available for 100 000 adults in both countries. Orthopaedic trained nurses, physiotherapists, and occupational therapists were few. Only 10 (6.7%) facilities in The Gambia and 56 (30.1%) in Zimbabwe had functioning X-ray facilities. Equipment for fracture immobilisation was widely unavailable. No public facility had a dual-energy X-ray absorptiometry scanner; antiresorptive treatment access was limited to < 5% facilities. Hip fracture readiness: only four facilities in The Gambia and 17 in Zimbabwe could offer surgery. Inpatient delays for surgery were long, especially in Zimbabwe. Non-operative management was common in Zimbabwe and in those visiting TBS in The Gambia. Over half TBS (51.4%) reported being able to set a hip fracture, management included traditional medicines (57.1%), splinting (20.0%), manipulation (14.3%) and traction (5.7%). Only 14.3% TBS referred hip fractures to hospital.

Findings highlight multiple important modifiable gaps in care which warrant urgent focus, with recommendations made, given expected increases in fragility fractures and need for universal health coverage.

This study investigates the effectiveness and adequacy of the informed consent process for patients undergoing hip fracture surgery. While informed consent is a legal and ethical responsibility, factors in the trauma setting can impair patients' understanding and retention of information. This study seeks to evaluate patients' recall of perioperative complications and explore their perceptions of the consent process.

A mixed-methods, multicentre cohort study will be conducted in the Southeast of Scotland. Adult patients with hip fractures will be recruited via purposive sampling. An information recall questionnaire will be administered within 36 hours of admission to assess unprompted and prompted recall of complications. A subset of participants will then undergo a semi-structured qualitative interview postoperatively to explore their experiences and perceptions of the consent process. Data will be analyzed using a social constructivist grounded theory to assess their perceptions of consent. Ethical approval has been granted by the East of England Research Ethics Committee (reference 23/EE/0233).

Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences. The study results will identify challenges in the consent process, particularly in how risks are communicated and understood. The data are expected to inform the development of information aids and enhance the ability of orthopaedic surgeons to provide comprehensive, patient-centred consent.

This study aimed to identify factors influencing delirium prevention (risk identification and screening), from the perspective of health service staff, in order to ascertain the characteristics and implementation strategies critical for the clinical adoption of data-driven optimisations for delirium prevention. This pre-implementation study used the Monash Learning Health System (LHS) paradigm to visualise iterative integrated assimilation of delirium prevention in routine care.

A qualitative study was conducted in a large metropolitan public health network in Australia. Following consultation with organisational leaders, a purposive sample of clinical/non-clinical participants with expertise in delirium care delivery was recruited. Interviews were inductively analysed using a framework approach. The Consolidated Framework for Implementation Research (CFIR) domains underpinned interview questions and guided thematic mapping and analysis of responses.

Semi-structured interviews were conducted with 18 participants (clinical [n = 14] and non-clinical [n = 4]). Key themes included challenges in consistently integrating delirium risk identification and screening processes into clinical workflows, infrastructure-related obstacles hindering the digitisation of decision support, and the need to engage caregivers and staff in designing optimisations to enable appropriate and timely delirium prevention.

This study generated insights into key factors influencing delirium prevention, focusing on the development and implementation of optimisations such as automated delirium risk prediction. Improving hospital information technology infrastructure, supporting workforce digital literacy and ensuring accountability in all professional groups are crucial for implementing automated delirium risk prediction models in clinical practice. Future research should examine the feasibility and efficacy of optimised delirium prevention interventions in pragmatic clinical trials.

Malnutrition, falls, and cognitive impairment are common in older patients visiting the emergency department (ED). Early recognition of these conditions could trigger interventions to improve outcomes following ED visits.

To analyze whether a simple risk screening protocol in the emergency medical services (EMS) identifies older patients at risk of ED readmission.

The EMS screened the falls risk, nutritional risk, and cognition of 472 patients (age ≥ 70 years) transported to the ED of a Finnish secondary care hospital between November 2018 and July 2019. Data on the risk screening, comorbidities, and ED readmissions were collected from electronic patient records. Data were analyzed using negative binomial regression, and the results are presented as incidence rate ratios (IRRs).

Altogether 312 patients (66%) experienced 880 ED readmissions during the 12-month follow-up. Nutritional risk was associated with an increased ED readmission rate across all time categories (< 1, 1-3, 3-6, and ≥ 6 months; IRRs 1.36-1.62, p-values < 0.05). Falls risk was associated with ED readmissions from one month after the index ED visit (IRRs 1.41-1.57, p-values < 0.05). Impaired cognition had no effect on readmissions (IRRs 1.14-1.26, p-values > 0.1).

Patients with nutritional risk or falls risk, identified by the EMS, had a higher ED readmission rate independent of comorbidity. EMS risk screening could supplement the assessment in the ED to better identify older patients who might benefit from more detailed assessment of their health status and interventions to prevent ED readmission.

Prognostic stratification in older patients with sepsis is challenging due to frailty and the role of multidrug-resistant (MDR) infections.

To test the predictive accuracy of different frailty measures, blood routine tests and MDR infection status for in-hospital mortality among older patients with sepsis.

Consecutive patients aged ≥ 65 years with qSOFA ≥ 2 and positive cultures admitted to a tertiary care hospital were enrolled. Frailty was assessed using the Clinical Frailty Scale (CFS), the Primary Care-Frailty Index (PC-FI), and a 50-item FI. A base logistic regression model including age, sex, WBC count, platelets, creatinine, hs-CRP, and lactate predicted mortality. Frailty indices and MDR status were sequentially added, and model performance was compared using the area under the Receiver Operating Characteristics (AUROC). A nomogram was developed to visualize mortality probabilities.

Among 93 patients (median age 80, IQR [72-84] years, 63.4% males), in-hospital mortality was 16.1%. Deceased patients were frailer and had a higher number of comorbidities. By logistic multivariable regression, the base model achieved an AUROC of 0.771 for predicting in-hospital mortality. Adding frailty indices improved model performance to 0.800 (PC-FI), 0.817 (CFS), and 0.823 (FI). Incorporating MDR status further increased AUROC to 0.890 (PC-FI + MDR), 0.907 (CFS + MDR), and 0.922 (FI + MDR), outperforming the base model (p < 0.05 for all).

Incorporating frailty indices and MDR status of culture isolates into traditional prognostic parameters improves mortality prediction in older patients admitted with sepsis, enabling more accurate risk stratification and personalized treatment strategies.

To examine baseline frailty and its association with rehospitalisation and mortality within 12 months among older adults enrolled in the Western Sydney Clinical Frailty Registry.

Prospective observational cohort study.

592 adults admitted to an acute geriatric medicine service in NSW, Australia, were included in this study.

The Western Sydney Clinical Frailty Registry is a study of adults admitted to acute geriatric wards in a 570-bed two-site district general hospital in Western Sydney, NSW, Australia. Recruitment began in April 2020 and is ongoing. Each participant is recruited while an inpatient and followed up for 12 months, including baseline visits and three-, six- and 12-month follow-ups via telephone interviews. The primary outcome of this study was rehospitalisation and/or mortality at 12 months.

Median age 82 years; half the cohort were classified as mild-moderately frail, and 21% were classified as severely frail. A total of 134 participants died (22.6%) within the 12-month follow-up period. Increased cumulative incidence of first rehospitalisation and/or death during the first 12 months post-discharge was significantly associated with higher modified Charlson comorbidity (p < 0.001) and Clinical Frailty Scale (CFS) scores (p < 0.001). Compared to the 'non-frail' group (CFS 1-4), those who were severely frail (CFS 7-9) had an 85% increased risk of rehospitalisation and/or death (95% CI 1.36-2.52), and those who were mild-moderately frail (CFS 5-6) had a 52% increased risk after adjusting for effects of the other variables (95% CI 1.18-1.94).

Frailty is very common in older adults admitted to acute geriatric services. Assessing frailty using the CFS is feasible and is independently predictive of rehospitalisation and mortality. Our findings suggest that integrating frailty assessment into clinical practice goes beyond simple risk stratification, offering valuable insights for tailored clinical management strategies.

Early detection of functional decline, a major risk among hospitalized older adults, can facilitate interventions that could significantly reduce it. We aimed to examine the contribution of the Timed Up and Go (TUG) test in predicting Hospitalization Associated Functional Decline (HAFD) among older adults, able to independently ambulate before admission. We used a cross-sectional study design; a total of 310 older adults (age ≥ 65) hospitalized in internal medicine wards between December 2018 and August 2020 were included; exclusion criteria were inability to ambulate, a diagnosis restricting mobility, hospitalization for end-of-life care, or impaired cognition. The Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients' independence in activities of daily living 2 weeks prior hospitalization, and at discharge. The TUG test was performed on admission and to predict significant functional decline (defined by a reduction of three points or more in the Modified Barthel Index), while accounting for demographics, length of hospitalization, comorbidity burden (Charlson's comorbidity index), and cognitive function (ALFI-MMSE). Participants were divided into three groups according to their TUG score-under or over a cut-off score of 12 s, or inability to complete the test. Adjusting for age, comorbidity, cognitive ability, and duration of hospitalization, the group that performed the test in less than 12 s showed no statistically significant change in the Modified Barthel Index, therefore no significant HAFD. The other groups showed a statistically significant decline in function. Risk for significant HAFD is currently underestimated in clinical settings, limited to subjective assessment, and underused in the context of implementing early interventions to prevent HAFD. The TUG may support screening for those at risk of hospitalizing-associated functional decline and could help identify patients suitable for preventative interventions.

Recent evidence suggests that frailty may be a more reliable measure than age to predict outcomes following trauma. Frailty leads to prolonged hospitalisation and increased burden on the hospital system in older patients. The aim of this study is to review the prevalence of frailty in our trauma patients and the association of frailty with hospital-based and twelve-month outcomes.

Patient demographics, discharge destination, hospital length of stay (LOS), and functional status at 12 months were reviewed. Frailty was assessed using the Clinical Frailty Scale (score <4 non frail, 4 vulnerable, >4 frail). Factors associated with frailty and outcomes including discharge destination (home or inpatient care) and LOS (p value <0.2) were included in multivariate models.

There were 1230 patients admitted to the trauma ward between November 2020-August 2021 who had linked registry data. Of these, 217 (17.6 %) were deemed frail with 131 (10.7 %) being vulnerable. In the group over 65 years, 38.6 % were frail and 16.1 % were vulnerable. Accounting for confounding factors (including age), being frail was associated with discharge to further inpatient care (AOR 4.82 (3.02 - 7.68), p value <0.001). At 12 months post injury, the mortality rate of patients with frailty was 28 %, compared to 2 % for the rest of the population and patients reported significantly more problems with undertaking daily tasks such as mobility and self-care.

After adjusting for confounding factors, frailty is associated with nearly five times the increase in odds of a discharge to further inpatient care. Long term outcomes are also significantly poorer for patients with frailty. Identifying frailty on admission may help outcomes by targeting this patient group and optimising healthcare resource usage.

The Australian Commission on Safety and Quality in Health Care 'National Standards' require general hospitals to have systems for clinicians to recognise and respond to patients' deteriorating mental state. The lack of an evidence-based operational definition and clear guidance challenges this requirement.

To review governance mechanisms and assessment processes for deteriorating mental state in a metropolitan general hospital and propose an organisational framework.

A qualitative document analysis using the READ approach systematically reviewed hospital committee reports, health district policies, and training programs to identify and synthesise key assessment points and processes.

The study mapped assessment points for recognising and responding to deteriorating mental state across patient journey stages. An organisational systems infographic provides a blueprint for meeting National Standards accreditation criteria.

Hospitals should establish comprehensive systems to observe, monitor, assess, and refer individuals with deteriorating mental state, involving multiple governance processes and frameworks.

Atrial fibrillation (AF) and coronary artery disease have several common risk factors, and 10-15% of patients with AF undergo percutaneous coronary intervention (PCI). Little is known about changes over time in modifiable risk factors and self-reported health in patients with and without a history of AF after PCI. Therefore, the aims were to determine and compare changes in modifiable risk factors and self-reported health in patients with and without a history of AF after PCI.

CONCARDPCI, a prospective multi-centre cohort study including patients after PCI, was conducted at seven high-volume PCI centres in Norway and Denmark (n = 3417). Of these, 408 had a history of AF. Data collection was conducted at the index admission and at 2-, 6-, and 12 months after discharge. Self-reported health was assessed with RAND-12 and the myocardial infarction dimensional assessment scale. Patients with a history of AF reported poorer health at baseline. However, the physical (P = 0.012) and mental (P < 0.001) health improved over time in both groups. The patients with a history of AF reported more emotional reactions (P = 0.029) and insecurities (P = 0.015). The proportion of smokers increased from 2- to 12 months in patients with a history of AF (P = 0.041), however, decreased in patients without AF from baseline to 6 months (P < 0.001).

An intensified focus on lifestyle interventions is needed to improve modifiable risk factors and self-reported health in patients with and without a history of AF after PCI.

An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium.

This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient's life.

We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge.

Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025.

In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening.

German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614.

DERR1-10.2196/59203.

Delirium is a neuropathological syndrome that is associated with several negative outcomes. Nursing home residents are vulnerable to developing delirium. Valid prevalence data and associated factors are not yet available for Germany. Therefore, the aim of the prevalence study of the DeliA project (Delirium in Nursing Homes) is to assess the prevalence of delirium and its associated factors in 750 nursing home residents.

Trained registered nurses from each participating nursing home will collect the data in a multicentre cross-sectional study. The inclusion criteria for residents are valid informed consent, age ≥65 years and sufficient language skills. The exclusion criteria are aphasia, coma, deafness or end-of-life status. The 4 'A's Test will be used as the primary measurement. Delirium motor subtypes will be determined using the Delirium Motor Subtype Scale. Covariables for associated factors, including functional impairments, pain, cognitive status and nutritional status, are assessed through standardised measurements. Moreover, data such as prescribed drugs or medical diagnosis, hearing impairment or falls will be assessed from the nursing records. Furthermore, the Drug Burden Index will be calculated, and associated factors will be determined using a logistic regression model. The period for data collection in participating nursing homes is planned for 2 consecutive weeks in April 2024.

This study was approved by the Ethics Committee of Witten/Herdecke University (no. 82/2023). Findings will be published in peer-reviewed journals and presented at conferences.

https://osf.io/xkfvh/ (DOI 10.17605/OSF.IO/XKFVH).

Delirium, frequently experienced by ischemic stroke patients, is one of the most common neuropsychiatric syndromes reported in the Intensive Care Unit (ICU). Stroke patients with delirium have a high mortality rate and lengthy hospitalization. For these reasons, early diagnosis of delirium in the ICU is critical for better patient prognosis. Therefore, we developed and validated prediction models to classify the real-time delirium status in patients admitted to the ICU or Stroke Unit (SU) with ischemic stroke.

A total of 84 delirium patients and 336 non-delirium patients in the ICU of Ajou University Hospital were included. The 8 fixed features [Age, Sex, Alcohol Intake, National Institute of Health Stroke Scale (NIHSS), HbA1c, Prothrombin time, D-dimer, and Hemoglobin] identified at admission and 12 dynamic features [Mean or Variability indexes calculated from Body Temperature (BT), Heart Rate (HR), Respiratory Rate (RR), Oxygen saturation (SpO2), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP)] based on vital signs were used for developing prediction models using the ensemble method.

The Area Under the Receiver Operating Characteristic curve (AUROC) for delirium-state classification was 0.80. In simulation-based evaluation, AUROC was 0.71, and the predicted probability increased closer to the time of delirium occurrence. We observed that the patterns of dynamic features, including BT, SpO2, RR, and Heart Rate Variability (HRV) kept changing as the time points were getting closer to the delirium occurrence time. Therefore, the model that employed these patterns showed increasing prediction performance.

Our model can predict the real-time possibility of delirium in patients with ischemic stroke and will be helpful to monitor high-risk patients.

Various factors contribute to postoperative delirium (POD) in elderly patients undergoing hip fracture surgeries. Sarcopenia was defined as the progressive loss of skeletal muscle mass and strength associated with aging. The aim of this study was to explore the prevalence of POD and sarcopenia in geriatric patients undergoing hip fracture surgeries and to investigate the correlation between preoperative sarcopenia and POD.

After applying specific inclusion and exclusion criteria, the information of 234 patients were retrospectively collected. POD was screened for with 4A's Test and diagnosed with DSM-5 criteria. The incidences of POD and sarcopenia were calculated. The demographic and perioperative features as well as comorbidities of delirious and non-delirious patients were analyzed and the risk factors analysis for POD in elderly hip fracture patients were conducted through univariate analysis and multivariate regression analysis.

48.7% patients were diagnosed of POD, 78.95% of which were females. The average age of delirious and non-delirious patients were 84.75 years and 80.63 years, respectively. The incidence of sarcopenia was 41.02% for all the included patients with 60.53% for delirious patients and 20.55% for non-delirious patients. Results of univariate analysis showed that sarcopenia (OR:5.281, 95%CI 2.988-9.337, p = 0.000), age increase per year (OR:1.128, 95CI 1.070-1.190, p = 0.000), operation duration increase (OR:1.017, 95%CI 1.004-1.030, p = 0.011), intertrochanteric fracture (OR:2.571, 95%CI 1.517-4.358, p = 0.000), dementia (OR: 6.029, 95%CI 2.532-14.359, p = 0.000), ASA > 2 (OR: 6.955, 95%CI 3.461-13.976, p = 0.000), coronary heart disease (OR: 2.201, 95%CI 1.257-3.854, p = 0.006), renal insufficiency (OR: 2.215, 95%CI 1.187-4.133, p = 0.012) and COPD (OR: 2.554, 95%CI 1.414-4.615, p = 0.002) were risk factors for POD. Results of multivariate analysis identified sarcopenia (OR: 2.457, 95% CI 1.226-4.923, p = 0.011), ASA > 2 (OR: 3.968, 95% CI 1.805-8.722, p = 0.001), dementia (OR: 3.912, 95% CI 1.390-11.014, p = 0.010) and coronary heart disease (OR: 2.176, 95% CI 1.044-4.538, p = 0.038) as independent risk factors for POD in geriatric hip fracture patients.

The incidences of POD and sarcopenia in geriatric hip fracture patients are high. Sarcopenia is an independent risk factor for POD in geriatric hip fracture patients.

Delirium is a common symptom following a traumatic brain injury that is often overlooked by healthcare professionals. Early detection of posttraumatic delirium is crucial to improving patient outcomes and quality of life. The 4 As Test (4AT: alertness, attention, abbreviated mental test-4, and acute mental changes) is a brief and rapid tool for delirium assessment with acceptable reliability and validity. However, the 4AT has not yet been translated for use in the Taiwanese population.

To translate the 4AT into Traditional Chinese (TC-4AT), assess its reliability and validity, and explore the clinical effects of delirium in patients with a traumatic brain injury.

This prospective observational study was conducted at the neurosurgery wards of 2 Taiwanese hospitals. Patients who were aged 20 years or older, were diagnosed with a traumatic brain injury, and had a Glasgow Coma Scale score between 13 and 15 were included. Interrater reliability was assessed, and validity was verified using criterion-related comparisons with the Short Confusion Assessment Method. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were employed to assess the sensitivity and specificity of the TC-4AT for screening posttraumatic brain injury delirium.

A total of 100 patients with an average age of 67 years were enrolled, of whom 10% were diagnosed with delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The interrater reliability of the TC-4AT was 1.00. Patients with delirium tended to have a longer hospital stay than those without delirium (13 days vs. 7 days) although the difference was nonsignificant (P = 0.28). In terms of criterion validity, patients diagnosed with delirium using the Short Confusion Assessment Method had a significantly higher score on the TC-4AT than those not diagnosed with delirium (P < 0.001). The receiver operating characteristic curve indicated that the optimal cutoff point was 4, with sensitivity, specificity, and area under the characteristic curve of 0.90, 0.94, and 0.96, respectively.

The TC-4AT is an accurate tool for delirium assessment that aids early detection and in informed decision-making in preventive care.

Disorientation is an early indicator of developing postoperative delirium (POD), which is associated with increased mortality and cognitive decline. The well-established "Confusion-Assessment-Method-for-Intensive-Care-Unit" (CAM-ICU) for diagnosing POD in intubated patients cannot make use of the feature 'disorientation', as this requires verbal communication. Other tools such as the 4AT test for disorientation but are not established in ICU settings. We therefore combined test-variables of the CAM-ICU (level of consciousness, fluctuating mental status and inattention) with verbal testing for disorientation to develop and enhance diagnostic accuracy of the "Confusion Assessment Method for Intermediate Care Unit" (CAM-IMC). In the present study we describe the development and the evaluation of the diagnostic accuracy of the CAM-IMC.

We conducted a prospective cohort-study to develop and evaluate the diagnostic accuracy of the CAM-IMC and disorientation for diagnosing POD in non-intubated patients undergoing elective cardiac surgery. All patients were eligible during data collection period. Exclusion criteria were preexisting brain-organic disease, age < 50 years, preoperative intubation, and insufficient language skills. Patients were assessed for POD using the CAM-IMC as the index-test by two independent examiners over three postoperative days. Reference-testing was conducted by experienced reference-raters. The primary outcome was the diagnostic test-performance.

Among 178 eligible patients, 624 paired observations were completed with 155 patients. Of these, 9% experienced POD. Sensitivity and specificity were 0.96 (CI-95%: 0.87-1.00) and 0.94 (CI-95%: 0.92-0.96), respectively. Area-Under-the-Receiver-Operating-Characteristic-Curve (AUROC; equivalent to c-statistic) for CAM-IMC with a cut-off at three points was 0.95 (CI-95%: 0.93-0.98). The interrater reliability was 0.80 (CI-95%: 0.69-0.91).

The CAM-IMC demonstrates excellent test performance for diagnosing POD in non-intubated patients by combining features of the CAM-ICU with 'disorientation'. Given an aging community with an increasing delirium risk, the CAM-IMC provides a highly structured assessment tool for POD. It enables early and accurate detection of delirium, which is critical for timely intervention and improved patient outcomes. The CAM-IMC appears to be a useful tool to be implemented in units for not-intubated patients and seems to be the perfect match where the CAM-ICU is already in use for monitoring POD.

DRKS00026980 (German registry of clinical studies).

Delirium and dementia are common causes of cognitive impairment in older adults. They are distinct but interrelated. Delirium, an acute confusional state, has been linked to the chronic and progressive loss of cognitive ability seen in dementia. Individuals with dementia are at higher risk for delirium, and delirium itself is a risk factor for incident dementia. Additionally, delirium in individuals with dementia can hasten underlying cognitive decline. In this review, we summarize recent literature linking these conditions, including epidemiological, clinicopathological, neuroimaging, biomarker, and experimental evidence supporting the intersection between these conditions. Strategies for evaluation and diagnosis that focus on distinguishing delirium from dementia in clinical settings and recommendations for delirium prevention interventions for patients with dementia are presented. We also discuss studies that provide evidence that delirium may be a modifiable risk factor for dementia and consider the impact of delirium prevention interventions on long-term outcomes.

The postoperative outcome of older people is significantly influenced by individual age-related risk factors. Therefore, factors such as frailty, cognitive impairment and functional dependency should be routinely included in the preoperative anesthesiological assessment of older patients. The approach recommended in the catalogue of criteria for geriatric trauma centers of the German Society for Trauma Surgery (DGU®) includes screening to identify geriatric patients, determination of frailty, assessment of cognitive impairment and delirium screening even in the emergency department. In addition, a basic geriatric assessment should be performed at the latest in the early postoperative phase to determine the need for further supportive therapy. Anesthesiologists work closely with geriatricians and trauma surgeons in the geriatric traumatological treatment. The recommendations for action and the nature of interdisciplinary collaboration are defined in standard operating procedures. It would be desirable to develop comparable concepts for the perioperative care of all older people beyond the field of geriatric traumatology.

Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years.

We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle-Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis.

We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16-20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52-2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns.

We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.

Delirium, also known as acute confusional state, is an acute brain disorder characterized by cognitive disturbances, particularly attentional deficits, potential behavioral changes, and altered vigilance, with a sudden onset and fluctuating course. It is a common condition among hospitalized older patients and has serious consequences for the patient, their family, and the healthcare system. It is considered an "acute brain failure" that often occurs in the context of underlying cognitive and cerebral vulnerability, similar to how acute kidney injury complicates chronic kidney disease or how acute heart failure exacerbates chronic heart failure - usually in the presence of a precipitating medical factor, often infectious, metabolic, perioperative, or neurological. This narrative review aims to describe the symptoms that allow the diagnosis of delirium in older adults, the available diagnostic or screening tools, as well as the complex and bidirectional relationships between delirium and dementia. The management of delirium, including non-pharmacological measures, will be discussed, along with symptomatic pharmacological treatments, which should be reserved for severe cases despite their low level of evidence.

Background/Objectives: Postoperative delirium is a prevalent and serious complication among elderly patients following surgical procedures. Prior research indicates that reduced competence in daily living, as evidenced by limitations in performing Activities of Daily Living (ADL), is directly associated with reduced patient mobility. This study aimed to investigate the potential role of preoperative mobility as a risk factor for the development of postoperative delirium. Methods: To assess preoperative mobility, a comprehensive geriatric evaluation of daily living competence was conducted. This included the Katz Index of Independence in ADL, which assessed basic daily activities over the preceding 14 days, and the Instrumental Activities of Daily Living Scale (IADL). Postoperatively, delirium monitoring was performed twice daily for seven days using validated delirium screening tools, including the Nursing Delirium Screening Scale, the Confusion Assessment Method, and the 4ATest. Results: A significant correlation was observed between the incidence of delirium and the IADL scores in all patients, with p < 0.001 for men and p = 0.001 for women. Among emergency patients, the Katz Index scores significantly differed between those who developed delirium and those who did not (p = 0.015). Additionally, a significant correlation was found between the Katz Index and the incidence of delirium in both groups (p < 0.001). Conclusions: The findings of this study emphasize the necessity of preoperative geriatric assessment using tools such as the Katz Index or IADL to identify patients at risk of delirium. The results confirm the importance of enhanced postoperative monitoring for potential delirium. For elective patients, prehabilitation should be considered when reduced daily living competence is identified. For emergency patients, immediate postoperative interventions, including intensive mobilization and orthogeriatric co-management, are recommended.

Background: Decreased cerebral oximetry (rSO2) in cardiac surgery is associated with postoperative delirium (POD). However, interventions optimizing intraoperative rSO2 are inconclusive. Methods: In this prospective observational cohort study, the relationship between rSO2, middle cerebral artery blood flow velocity (MCAV), and processed EEG was assessed in cardiac surgery patients with and without POD. MCAV was continuously recorded by transcranial Doppler sonography (TCD), together with continuous rSO2 and bispectral index (BIS) monitoring. Cardiopulmonary bypass (CPB) flow rate was adjusted according to body surface area. The cohort was divided into the POD and control groups, according to the postoperative results of the confusion assessment method (CAM/CAM-ICU), the 4A's test (4AT), and the Delirium Observation Scale (DOS). A mixed model analysis was performed for intraoperative raw data. The cerebral autoregulation index was calculated from TCD, rSO2, and arterial pressure values. Differences in impaired autoregulation were compared using the Mann-Whitney U test. Results: A total of 41 patients were included in this study. A total of 13 patients (36.11%) developed postoperative delirium. There were no significant differences in the baseline characteristics of patients with or without POD. Patients with POD had lower BIS values during CPB (adjusted mean difference -4.449 (95% CI [-7.978, -0.925])). RSO2 was not significantly reduced in POD, (adjusted mean difference: -5.320, 95% CI [-11.508, 0.874]). In contrast, MCAV was significantly increased in POD (10.655, 95% CI [0.491, 20.819]). The duration of cerebral autoregulation impairment did not differ significantly for TCD and cerebral oximetry-derived indices (p = 0.4528, p = 0.2715, respectively). Conclusions: Our results suggest that disturbed cerebral metabolism reflects a vulnerable brain which may be more susceptible to overperfusion during CPB, which can be seen in increased MCAV values. These phenomena occur irrespectively of cerebral autoregulation.

In critically ill patients, delirium is a prognostic indicator of morbidity and mortality.

This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation.

This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared preimplantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as reintubation rate, length of stay, discharge disposition, and readmission rates.

In total, 361 patients (26.7% women and 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Preimplantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P = 0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P = 0.007), 6-month (P = 0.004), and in-hospital mortality (P < 0.001), unplanned reintubations (P < 0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and intensive care unit length of stay were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to the hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant.

In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse postsurgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.

Dementia, or major neurocognitive disorder, is defined as a decline in 1 or more cognitive domains that causes impairment in everyday function. Alzheimer disease is the most common type of dementia in the United States, with an estimated 6.9 million adults who have Alzheimer disease and are 65 years or older. This article discusses the latest findings in preventing cognitive decline. It also discusses dementia screening, diagnosis, treatment, and the quality of life for persons with dementia and their caregivers.

Individuals waiting for total-knee-replacement surgery are at risk of developing morbidities and frailty which may affect their postoperative recovery. Multi-modal prehabilitation could mitigate these unintentional effects.

To implement and evaluate a specified online multi-modal prehabilitation intervention in patients waiting for total-knee-replacement surgery in a large urban acute hospital trust.

A non-randomised, pre/post analysis implementation pilot with a nested qualitative study was conducted and is reported following the standards for implementation studies (StaRI) guidance. Of 35 listed cases, 12 (34%) were eligible, recruited, and completed an 8-week multi-modal online intervention incorporating 5 modalities (i) cardiovascular exercise, (ii) strength/balance function, (iii) smoking cessation, (iv) opioid use, (v) nutritional intake. Interventions were specified using the Rehabilitation Treatment Specification System, where rehabilitation treatment theory accounts for discrete treatment components. Two participated in an online qualitative interview post-intervention. Process evaluation included intervention fidelity, eligibility/recruitment/retention rates, and clinical outcomes included knee function, frailty, gait velocity, anxiety/depression, and quality of life.

Five participants (42%) completed the intervention and were retained at follow-up. The intervention was delivered online at specified doses, frequency/durations indicative of high respective adherence, quantity, and exposure fidelity. There was significant improvement in median oxford knee score (p = 0.015), gait velocity (p = 0.040) and anxiety (p = 0.023). The interview revealed 5 themes; surgery preconceptions, motivation, acceptability, postoperative experiences, and future recommendations confirming acceptance of the intervention by virtue of adhering to the treatment exposure delivered as planned.

The specified multi-modal prehabilitation was acceptable, implementable, and demonstrated evidence of preliminary efficacy. Further experimental pilot work that represents the spectrum of frailty, obesity, quality of life, and comorbidities associated with total-knee-replacement surgery is indicated.

Published data on whether post-stroke delirium (PSD) is an independent predictor of outcomes in patients with acute stroke are inconsistent and have not yet been synthesized and quantified via meta-analyses.

This systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The study protocol involved a search of the PubMed, Embase, PsycINFO, and Medline databases from 1946 to November 1, 2023, of which prospective observational and case-control studies were included. The quality of the included studies was rated using the Newcastle Ottawa Scale. Pooled effect estimates calculated using a random-effects model were expressed as the odds ratios (ORs), hazard ratios (HRs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023472551).

The search yielded 39 eligible articles comprising 3295 and 9643 patients with and without PSD, respectively. Thirty studies were high quality, while 9 had moderate quality. The primary analyses, adequately adjusting for predefined confounders, showed that PSD was significantly associated with mortality risk (average follow-up of 19.50 months; OR, 3.47; 95% CI, 2.35-5.12; I2, 26.0%) and poor neurological function (average follow-up of 21.75 months; OR, 3.62; 95% CI, 2.15-6.09; I2, 0). Secondary analyses, with or without inadequate adjustment, showed that PSD was significantly associated with prolonged hospital length of stay, increased risk of institutionalization, poor cognitive outcomes, and quality of life after discharge.

This systematic review and meta-analysis provides evidence that PSD was independently associated with mortality and poor neurological function after controlling for pre-specified confounders. The prevention of PSD remains a high clinical and research priority.

As part of the Geriatric Emergency Department (ED) Guidelines 2.0 project, we conducted a systematic review to find risk factors or risk stratification approaches that can be used to identify subsets of older adults who may benefit from targeted ED delirium screening.

An electronic search strategy was developed with a medical librarian, conducted in April 2021 and November 2022. Full-text studies of patients ≥65 years assessed for prevalent delirium in the ED were included. Risk of bias was assessed using the McMaster University Clarity Group tool. Outcomes measures pertained to the risk stratification method used. Due to heterogeneity of patient populations, risk stratification methods, and outcomes, a meta-analysis was not conducted.

Our search yielded 1878 unique citations, of which 13 were included. Six studies developed a novel delirium risk score with or without evaluation of specific risk factors, six studies evaluated specific risk factors only, and one study evaluated an existing nondelirium risk score for association with delirium. The most common risk factor was history of dementia, with odds ratios ranging from 3.3 (95% confidence interval [CI] 1.2-8.9) to 18.33 (95% CI 8.08-43.64). Other risk factors that were consistently associated with increased risk of delirium included older age, use of certain medications (such as antipsychotics, antidepressants, and opioids, among others), and functional impairments. Of the studies that developed novel risk scores, the reported area under the curve ranged from 0.77 to 0.90. Only two studies reported potential impact of the risk stratification tool on screening burden.

There is significant heterogeneity, but results suggest that factors such as dementia, age over 75, and functional impairments should be used to identify older adults who are at highest risk for ED delirium. No studies evaluated implementation of a risk stratification method for delirium screening or evaluated patient-oriented outcomes.

Validations of brief delirium tools have not included analysis of psychiatric disorders comorbidities or control groups. We validated the Delirium Diagnostic Tool-Provisional (DDT-Pro) in 422 geriatric inpatients with high incidence of depression and/or dementia.

Cross-sectional study using two delirium reference standards, DSM-5-TR and Delirium Rating Scale-Revised-98 (DRS-R98). We assessed concurrent and construct DDT-Pro validity too.

There were 117 (27.7%) delirium cases using DDT-Pro, 104 (24.6%) per DSM-5-TR and 93 (22.0%) per DRS-R98; 133 patients (31.5%) had depression and 105 (24.9%) dementia, some comorbid with delirium. DDT-Pro accuracy (AUC under ROC curve) ranges were 88.3-95.9% vs DSM-5-TR and 92.7-95.0% vs DRS-R98 for whole sample and four diagnostic groups, without statistical differences. DDT-Pro ≤6 had the most balanced sensitivity-specificity for delirium diagnosis against both DSM-5-TR and DRS-R98 with similar specificity but higher sensitivity for DRS-R98 than DSM-5-TR delirium, with the highest values in patients with depression and dementia (≥92% sensitivity, ≥81% specificity). Positive and negative likelihood ratios support diagnostic strength. Concurrent validity was high reflected by significant correlations (p < 0.001) of DDT-Pro total and item scores with DRS-R98 and Delirium Frontal Index scores, highest in groups with comorbid depression and/or dementia. The DDT-Pro represented a single construct for delirium demonstrated by one factor with high item loadings and high internal consistency reliability of its items.

The DDT-Pro demonstrated strong performance metrics in general hospital elderly inpatients with preexisting depression and/or dementia, which is unique among brief delirium tools. Its optimized cutoff score was the same as in other populations.

Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test-treatment thresholds for ED delirium screening.

We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta-analysis and estimated delirium screening thresholds.

Full-text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta-analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7-20.7) and rule out (pooled negative likelihood ratio [LR-] 0.18, 95% CI 0.09-0.34) delirium. We also conducted meta-analysis of two studies that quantified the accuracy of the Abbreviated Mental Test-4 (AMT-4) and found that the pooled LR+ (4.3, 95% CI 2.4-7.8) was lower than that observed for the 4AT, but the pooled LR- (0.22, 95% CI 0.05-1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%.

The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED-based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM-ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single-center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single-center study.

The aim of this retrospective study was to identify independent prognostic factors for developing a postoperative delirium (POD) in patients suffering from a proximal femoral neck fracture and treated by implantation of a hemiprosthesis.

A retrospective study, including patients with hip hemiarthroplasty due to a femoral neck fracture between 2011 and 2020 was performed. Demographic data, preexisting conditions, intra-/postoperative complications, mobilization and laboratory results were extracted from the patients' charts. The different parameters were analyzed comparing patients with and without POD.

412 patients, mean age of 81 ± 9.58 years were included, 66.5% (n = 274) were female, 18.2% (n = 75) of them developed a POD. Significantly higher incidence of POD was associated with older age (p < 0.001), lower level of haemoglobin (p < 0.001), higher post-surgery interleukin 6 (IL 6) level (p = 0.008), higher postoperative level of leukocytes (p = 0.01). Patients with POD received more units of packed red blood cells (PRBC) (p = 0.007). Patients with no mobility limitations pre-operatively developed POD less frequently (p = 0.01), whereas suffering from pneumonia (p = 0.03) or limited mobility postoperatively increased the risk of POD (p < 0.001).

This study could help to identify patients with a risk for developing POD after a hemiarthroplasty in femoral neck fractures. As a consequence, frequent controls of Hb, IL 6 and leucocytes levels to avoid anemia and infections, as well as the well surgical treatment to guarantee a good postoperative outcome.

The aim of this study is to analyze the association between the degree of frailty and inappropriate prescribing patterns at admission to an Acute Care of the Elderly Unit (ACE Unit).

Prospective observational study conducted in the ACE Unit of an acute hospital in Barcelona city between June and August 2021. Epidemiological and demographic data were collected during hospitalization. Comprehensive geriatric assessment was performed on admitted patients. We recorded frailty (FRAIL scale), extreme polypharmacy (10 or more drugs), central nervous system potentially inappropriate medications-PIMs (STOPP-CNS or group D), cardiovascular potential prescribing omissions-PPOs (START-CV or group A), and anticholinergic burden using the drug burden index (DBI).

Ninety-three patients were included, of whom 48 (51.6%) were male, with a mean age of 82.83 (SD 7.53) years. The main diagnosis upon admission was heart failure in 34 patients (36.6%). Frail patients were older, with more dependence of activities of daily living and more comorbidity than non-frail patients. Additionally, frail patients demonstrated more omissions according to the START-A criteria. No statistically significant differences were observed in term of extreme polypharmacy, PIMs, or anticholinergic burden.

In the current study we found an association between frailty and inappropriate prescribing, specifically with regard to omissions using the START criteria for the cardiovascular system (group A). Notably, frail patients exhibited more omissions compared to their non-frail counterparts, and this difference was statistically significant.

Delirium is a common and reversible neurobehavioral condition with significant morbidity and mortality ramifications for older patients. Consequentially, clear guidelines exist pertaining to its swift identification and management. However, studies suggest that adherence to these guidelines are poor. This audit aimed to evaluate compliance to the National Institute for Health and Care Excellence's (NICE) delirium guidelines in an Acute Senior Health Unit (ASHU) and to present a single centre experience of a low-cost ward-based intervention for improving delirium guideline adherence.

A retrospective observational audit was conducted on patients admitted to ASHU between 01/07/2023 and 30/07/2023. Data on delirium assessments, diagnoses and causes of delirium were obtained through retrospective database searches. Posters and education based multidisciplinary team (MDT) interventions were designed and initiated following grounded thematic literature analysis and ward discussion. A methodically equivalent audit was then conducted between 01/09/2023 and 30/09/23. Data was anonymised and blinded and analysis was performed on SPSS V12.0.

A total of 128 patients were included in the study. Initial audit revealed suboptimal compliance with NICE recommendations. Chi-square test of independence found that patients were statistically more likely to receive a full delirium assessment (1.9% vs. 56.6%, p = 0.001) and formal diagnosis (5.8% vs. 27.6%, p = 0.002) after the ward-based intervention.

This study provides limited evidence in favour of low-cost MDT based interventions for improving adherence to NICE delirium guidelines and provides a 5-step framework for future studies. This study also explores the potential patient implications of these interventions. A repeat audit should be conducted to ensure lasting and sustainable change is achieved.

AUDI003614.

Delirium is strongly associated with poor health outcomes, yet it is frequently underdiagnosed. Limited research on delirium has been conducted in Nursing Homes (NHs). Our aim is to assess delirium prevalence and its associated factors, in particular pharmacological prescription, in this care setting.

Data from the Italian "Delirium Day" 2016 Edition, a national multicenter point-prevalence study on patients aged 65 and older were analyzed to examine the associations between the prevalence of delirium and its subtypes with demographics and information about medical history and pharmacological treatment. Delirium was assessed using the Assessment test for delirium and cognitive impairment (4AT). Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS).

955 residents, from 32 Italian NHs with a mean age of 84.72 ± 7.78 years were included. According to the 4AT, delirium was present in 260 (27.2%) NHs residents, mainly hyperactive (35.4%) or mixed subtypes (20.7%). Antidepressant treatment with selective serotonin reuptake inhibitors (SSRIs) was associated with lower delirium prevalence in univariate and multivariate analyses.

The high prevalence of delirium in NHs highlights the need to systematically assess its occurrence in this care settings. The inverse association between SSRIs and delirium might imply a possible preventive role of this class of therapeutic agents against delirium in NHs, yet further studies are warranted to ascertain any causal relationship between SSRIs intake and reduced delirium incidence.