Alessandro Morandi1, Elena Lucchi2, Renato Turco3, Sara Morghen4, Fabio Guerini5, Rossana Santi6, Simona Gentile7, David Meagher8, Philippe Voyer9, Donna Fick10, Eva M Schmitt11, Sharon K Inouye12, Marco Trabucchi13, Giuseppe Bellelli14. 1. Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: morandi.alessandro@gmail.com. 2. Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: elena.lucchi@ancelle.it. 3. Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: renatoturco@virgilio.it. 4. Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: sara.morghen@ancelle.it. 5. Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: fabio.guerini@ancelle.it. 6. Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: rossana.santi@ancelle.it. 7. Department of Rehabilitation and Aged Care of the Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: simona.gentile@ancelle.it. 8. Graduate-entry Medical School, Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity, Graduate Entry Medical School, University of Limerick, Limerick, Ireland. Electronic address: david.meagher@ul.ie. 9. Faculty of Nursing sciences, Université Laval, Quebec City, Canada. Electronic address: philippe.voyer@fsi.ulaval.ca. 10. College of Nursing, The Pennsylvania State University, USA. Electronic address: dmf21@psu.edu. 11. Hebrew SeniorLife, Institute for Aging Research, Harvard Medical School, USA. Electronic address: EvaSchmitt@hsl.harvard.edu. 12. Hebrew SeniorLife, Institute for Aging Research, Harvard Medical School, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: sharoninouye@hsl.harvard.edu. 13. Geriatric Research Group, Brescia, Italy; University of Tor Vergata, Rome, Rome, Italy. Electronic address: trabucchi.m@grg-bs.it. 14. Geriatric Research Group, Brescia, Italy; Department of Health Sciences, University of Milano-Bicocca and Geriatric Medicine, San Gerardo Hospital, Monza, Italy; Milan Center for Neuroscience (Neuro-Mi), Milan, Italy. Electronic address: giuseppe.bellelli@unimib.it.
Abstract
OBJECTIVE: Delirium superimposed on dementia is common and is associated with adverse outcomes. Yet little is known about the patients' personal delirium experiences. We used quantitative and qualitative methods to assess the delirium superimposed on dementia experience among older patients. METHODS: We conducted a prospective cohort study among patients with delirium superimposed on dementia who were admitted to a rehabilitation ward. Delirium was diagnosed using DSM-IV-TR criteria. Delirium severity and symptoms were evaluated with the Delirium-O-Meter (D-O-M). The experience of delirium was assessed after delirium resolution (T0) and one month later (T1) with a standardized questionnaire and a qualitative interview. Level of distress was measured with the Delirium Experience Questionnaire. RESULTS: Of the 30 patients included in the study, 50% had mild dementia; 33% and 17% had moderate and severe dementia. Half of the patients had evidence of the full range of D-O-M delirium symptoms. We evaluated 30 patients at T0 and 20 at T1. At T0, half of the patients remembered being confused as part of the delirium episode, and reported an overall moderate level of related distress. Patients reported high distress related to memories of anxiety/fear, delusions, restlessness, hypokinesia, and impaired orientation. Qualitative interviews revealed six main aspects of patient delirium experiences: Emotions; Cognitive Impairment; Psychosis; Memories; Awareness of Change; and Physical Symptoms. CONCLUSIONS: The study provides novel information on the delirium experience in patients with dementia. These findings are the key for health care providers to improve the everyday care of this important group of frail older patients.
OBJECTIVE:Delirium superimposed on dementia is common and is associated with adverse outcomes. Yet little is known about the patients' personal delirium experiences. We used quantitative and qualitative methods to assess the delirium superimposed on dementia experience among older patients. METHODS: We conducted a prospective cohort study among patients with delirium superimposed on dementia who were admitted to a rehabilitation ward. Delirium was diagnosed using DSM-IV-TR criteria. Delirium severity and symptoms were evaluated with the Delirium-O-Meter (D-O-M). The experience of delirium was assessed after delirium resolution (T0) and one month later (T1) with a standardized questionnaire and a qualitative interview. Level of distress was measured with the Delirium Experience Questionnaire. RESULTS: Of the 30 patients included in the study, 50% had mild dementia; 33% and 17% had moderate and severe dementia. Half of the patients had evidence of the full range of D-O-M delirium symptoms. We evaluated 30 patients at T0 and 20 at T1. At T0, half of the patients remembered being confused as part of the delirium episode, and reported an overall moderate level of related distress. Patients reported high distress related to memories of anxiety/fear, delusions, restlessness, hypokinesia, and impaired orientation. Qualitative interviews revealed six main aspects of patientdelirium experiences: Emotions; Cognitive Impairment; Psychosis; Memories; Awareness of Change; and Physical Symptoms. CONCLUSIONS: The study provides novel information on the delirium experience in patients with dementia. These findings are the key for health care providers to improve the everyday care of this important group of frail older patients.
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