Elsevier

General Hospital Psychiatry

Volume 26, Issue 1, January–February 2004, Pages 31-35
General Hospital Psychiatry

Original article
Detection and documentation of dementia and delirium in acute geriatric wards

https://doi.org/10.1016/j.genhosppsych.2003.08.003Get rights and content

Abstract

Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders.

Introduction

Dementia and delirium are two common psychiatric disorders causing cognitive decline among older individuals. Early detection of these syndromes is desirable as both have a poor prognosis [1], [2], [3] and beneficial treatments are available [4], [5], [6], [7], [8].

Several studies have been published on detection of cognitive impairment in hospital settings. The recognition rate varied greatly, from 15.7 to 79% [9], [10], [11], [12], [13], [14]. However, the authors are familiar of only two studies assessing detection of dementia by physicians in hospital settings, with reported detection rates of 26.8% [15] and 84.6% [10]. To our knowledge, no studies have addressed the question of how physicians perform detailed and etiological diagnoses of dementia in their patients.

Numerous studies have also been published on detection of delirium, with reported rates of 6 to 93% by nurses [15], [16], [17] and 17 to 93% by physicians [9], [10], [11], [12], [15], [16], [17], [18], [19], [20], [21].

The purpose of this study was to investigate how physicians and nurses detect and distinguish between dementia and delirium among aged patients in acute hospital care. We also wanted to clarify in which detail physicians assess and detect cognitive decline in their patients.

Section snippets

Patients and methods

This study consisted of interviews and observations of patients in seven acute wards in two geriatric hospitals in Helsinki, Finland. All available patients during the study period were eligible to participate, excluding those aged less than 70 years or in a coma. After complete description of the study to subjects, written informed consent was obtained. In cases of poor judgement capacity or moderate cognitive impairment, informed consent was acquired from the patient's closest proxy. The

Results

Of the 241 patients eligible for enrollment, consent to participate was obtained from 230 (95.4%). Review of medical records was performed for 219/230. Patient demographic variables are shown in Table 1.

Dementia was defined by researchers (golden standard) for 88/219 (40.2%) subjects (Table 1). As a possible sign of a detected cognitive decline, ward physicians had given an order to perform cognitive testing on 42 of these 88 subjects (Fig 1). Ward physicians had also recorded some mention of

Discussion

Over 90% of patients we defined as having dementia were at least suspected of suffering from cognitive decline by their physicians. Unfortunately, a more detailed diagnostic procedure was not always performed, and only about half of these patients were subsequently diagnosed as having dementia. A specific, etiological diagnosis of the dementia was provided for less than 5% of dementia patients, resulting in only incidental actions to provide them with effective treatment with cholinesterase

Acknowledgements

This study was supported by the La Carita Foundation, Uulo Arhio Foundation, The Academy of Finland (Grant No. 48613), and the Helsinki University Central Hospital.

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