The Risk Factors for Delirium in Patients with Stroke in Palliative Care

Year 2022, , 86 - 90, 15.01.2022

Gülhan Sarıçam , Orkun Sarıçam

https://doi.org/10.16899/jcm.969181

Abstract

Aim: Post-stroke delirium is an acute neuropsychiatric syndrome that increases the distress of patients and family members and leads to long-term results, especially in older age. In this study, we aimed to investigate the risk factors for delirium in patients followed-up in palliative care with the diagnosis of stroke.
Material and Method: This retrospective study included 161 patients followed-up in the palliative care ward with the diagnosis of stroke. Patients diagnosed with stroke were grouped as ischemic stroke (IS), hemorrhagic stroke (HS) and subarachnoid hemorrhage (SAH). The age, gender, Glasgow coma scale (GCS), percutaneous endoscopic gastrostomy (PEG) status, presence of infection, electrolyte values, length of hospitalization, discharge conditions and comorbid diseases of the patients included in the study were evaluated.
Results: The average age of the patients was 70.49 ± 15.269 years, the length of hospitalization was 46.6 ± 16.11 days, and 35 (21.1%) patients had been diagnosed with delirium. In patients who developed delirium, the ages were significantly lower, the infection rates were significantly higher, and the length of hospitalization was significantly longer (p=0.046, p<0.001, p=0.003). While the proportion of patients with a PEG was significantly lower, the rate use of anticholinergics, narcotic analgesics, antiepileptics and antipsychotics was significantly higher in patients who had developed delirium.
Conclusion: We think that determining and managing the risk factors for delirium development in stroke patients followed-up in palliative care will decrease the morbidity and improve the quality of life of the patients and that further studies on this topic are needed.

Keywords

Palliative care, stroke, delirium, length of hospitalization.

References

• 1.American Psychiatric Association. Diagnostic and statistical manual of mental disorders, (Fifth Edition ed). Arlington: American Psychiatric Association, 2013.
• 2. Creutzfeldt CJ, Longstreth WT, Holloway RG. Predicting decline and survival in severe acute brain injury: the fourth trajectory. BMJ. 2015; 351: h3904.
• 3. McManus J, Pathansali R, Stewart R, Macdonald A, Jackson S. Delirium Post-Stroke. Age Ageing. 2007; 36(6): 613-8.
• 4. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in Elderly People. Lancet. 2014; 383(9920): 911-22.
• 5. Holloway RG, Arnold RM, Creutzfeldt CJ, et al. Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45: 1887–916.
• 6. Holloway RG, Ladwig S, Robb J, Kelly A, Nielsen E, Quill TE. Palliative Care Consultations in Hospitalized Stroke Patients. J Palliat Med. 2010;13(4): 407–412.
• 7. Eastman P, McCarthy G, Brand CA, Weir L, Gorelik A, Le B. Who, Why and When: Stroke Care Unit Patients Seen by a Palliative Care Service Within a Large Metropolitan Teaching Hospital. BMJ Support Palliat Care. 2013; 3(1): 77-83.
• 8. Patel MB, Bednarik J, Lee P, et al. Delirium Monitoring in Neurocritically Ill Patients: A Systematic Review. Critical care medicine. 2018; 46(11): 1832–41.
• 9. Naidech AM, Beaumont JL, Rosenberg NF, et al. Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort. American journal of respiratory and critical care medicine. 2013; 188(11): 1331–7.
• 10. Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliat Med. 2013; 27(6): 486–98.
• 11.Kim H, Chung S, Ho Joo Y, Lee JS. The major risk factors for delirium in a clinical setting. Neuropsychiatr Dis Treat. 2016; 12: 1787–93.
• 12. Shi Q, Warren L, Saposnik G, MacDermid JC. Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy. Neuropsychiatr Dis Treat. 2013; 9: 1359–70.
• 13. Langhorne P, Stott DJ, Robertson L, et al. Medical complications after stroke: A multicenter study. Stroke. 2000; 31(6): 1223–29.
• 14. Vahidy FS, Bambhroliya AB, Meeks JR, et al. In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium. PLoS One. 2019; 14(11): e0225204.
• 15. Simone MJ , Tan ZS. The Role of Inflammation in the Pathogenesis of Delirium and Dementia in Older Adults: A Review. CNS Neurosci Ther. 2011; 17(5): 506–13.
• 16. Caeiro L, Ferro JM, Claro MI. Delirium in acute stroke: a preliminary study of the role of anticholinergic medications. Eur J Neurol. 2004; 11: 699–704.
• 17. McManus J, Pathansali R, Hassan H, et al. The course of delirium in acute stroke. Age and Aging. 2009; 38: 385–9
• 18. Nydahl P, Bartoszek G, Binder A, et al. Prevalence for delirium in stroke patients: A prospective controlled study. Brain Behav. 2017; 7(8): e00748.
• 19.Khurana V, Gambhir IS, Kishore D. Evaluation of delirium in elderly: a hospital-based study. Geriatr Gerontol Int. 2011; 11: 467–73.
• 20.Kotfis K, Bott-Olejnik M, Szylińska A, Listewnik M, Rotter I. Characteristics, Risk Factors And Outcome Of Early-Onset Delirium In Elderly Patients With First Ever Acute Ischemic Stroke - A Prospective Observational Cohort Study. Clin Interv Aging. 2019; 14: 1771–82.
• 21.Bush SH, Tierney S, Lawlor PG. Clinical Assessment and Management of Delirium in the Palliative Care Setting. Drugs. 2017; 77(15): 1623–43.
• 22. N Jackson , J Doherty, S Coulter. Neuropsychiatric Complications of Commonly Used Palliative Care Drugs. Postgrad Med J. 2008; 84(989): 121-6
• 23. Gustafson Y, Olsson T, Eriksson S, Asplund K, Bucht G. Acute confusional states (delirium) in stroke patients. Cerebrovasc Dis. 1991; 1: 257–64.