Determining Risk Factors for Delirium Among Elderly Patients in The Emergency Care Settings

Abstract

Objective: Delirium is reported as a common clinical state among elderly patients seeking care in the emergency departments (ED). However, it is commonly underdiagnosed in the ED. This study aimed to evaluate delirium prevalence and determine the risk factors for developing delirium in elderly patients in ED. Material and Methods: The study included 238 patients who were ≥65 years old and visited the emergency department (ED). The emergency specialist used the ‘Confusion assessment method (CAM)’ to screen for delirium in the patient group. A psychiatrist then evaluated the patients according to DSM-5 criteria for delirium. Demographic data, vital signs, and laboratory findings of the patients were also recorded as part of the study. Results: Delirium was identified in 10.9% of the patients through CAM and 11.8% of the patients according to DSM-5 criteria. No statistically significant difference was found between the groups with and without delirium in terms of age, gender, comorbidities, presence of dementia, and use of polypharmacy. A positive correlation between mean arterial blood pressure (MABP) (r=0.373, p<0.001), pulse rate (r=0.208, p<0.001), and respiratory rate (r=0.284, p<0.001) and a negative correlation between CRP levels (r=-0.139, p=0.032) and the presence of delirium were found. Logistic regression analysis showed that MABP>99 mmHg and respiratory rate>19/min are associated risk factors for delirium. Conclusion: High MABP and respiratory rate could be related to delirium risk. Although the hemodynamic risk factors could contribute to the recognition of delirium, practical clinical screening tools are still the most important and reliable methods to detect delirium.

Keywords

• Delirium
• emergency department
• elderly
• related factors

Acil Servise Başvuran Yaşlı Hastalarda Deliryum İçin Risk Faktörlerinin Belirlenmesi

Abstract

Amaç: Deliryum, acil servislere başvuran yaşlı hastalarda sık görülen bir klinik durum olmakla birlikte, tanısı genellikle atlanmaktadır. Bu çalışmada acil servise başvuran yaşlı hastalarda deliryum prevalansının değerlendirilmesi ve deliryum için risk faktörlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Acil servise başvuran 65 yaş üstü 238 hasta çalışmaya dahil edildi. Hasta grubu acil servis uzmanı tarafından ‘Konfüzyon Değerlendirme Yöntemi (KDY)’ kullanılarak deliryum açısından tarandı. Hastalar daha sonra bir psikiyatrist tarafından DSM-5 kriterlerine göre deliryum açısından değerlendirildi. Hastaların demografik verileri, vital bulguları ve laboratuvar bulguları kaydedildi. Bulgular: KDY ile hastaların %10,9’unda, DSM-5 kriterlerine göre hastaların %11,8’inde deliryum tanısı saptandı. Deliryum olan ve olmayan gruplar arasında yaş, cinsiyet, ek hastalık, demans ve polifarmasi varlığı açısından istatistiksel olarak anlamlı bir fark saptanmadı. Ortalama arteriyel kan basıncı (OAKB) (r=0,373, p<0,001), nabız (r=0,208, p<0,001) ve solunum sayısı (r=0,284, p<0,001) ve deliryum arasında pozitif, CRP düzeyleri (r=-0,139, p=0,032) ve deliryum varlığı arasında ise negatif korelasyon saptandı. Lojistik regresyon analizi sonuçları, OAKB> 99 mmHg ve solunum hızı> 19/dk’nın üzerinde olmasının deliryum için risk faktörü olabileceğini gösterdi. Sonuç: Yüksek OAKB ve solunum hızı deliryum riski ile ilişkili olabilir. Hemodinamik risk faktörleri deliryumun tanınmasına katkıda bulunabilse de, pratik klinik tarama araçları deliryumu saptamak için hala en önemli ve güvenilir yöntemlerdir.

Keywords

• deliryum
• acil servis
• yaşlı
• ilişkili faktörler

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