Alessandro Morandi1, Marco Inzitari2, Cristina Udina2, Neus Gual3, Miriam Mota3, Elena Tassistro4, Anita Andreano4, Antonio Cherubini5, Simona Gentile6, Enrico Mossello7, Alessandra Marengoni8, Anna Olivé9, Francesc Riba10, Domingo Ruiz11, Elisabet de Jaime12, Giuseppe Bellelli13. 1. Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy; Geriatric Research Group, Brescia, Italy; REFiT Bcn Research Group, Parc Sanitari Pere Virgili and Vall d'Hebrón Institut de Recerca (VHIR), Barcelona, Spain. Electronic address: morandi.alessandro@gmail.com. 2. REFiT Bcn Research Group, Parc Sanitari Pere Virgili and Vall d'Hebrón Institut de Recerca (VHIR), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. 3. REFiT Bcn Research Group, Parc Sanitari Pere Virgili and Vall d'Hebrón Institut de Recerca (VHIR), Barcelona, Spain. 4. Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy. 5. Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA Ancona, Italy. 6. Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy; Geriatric Research Group, Brescia, Italy. 7. University of Florence, Carreggi University Hospital, Florence, Italy. 8. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 9. Hospital Mare de Déu de la Mercè, Barcelona, Spain. 10. Hospital de la Santa Creu, Jesus-Tortors, Tarragona, Spain. 11. Fundació Althaia, Manresa, Spain; Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain. 12. Geriatrics Department, University Hospital Parc de Salut Mar, Barcelona, Spain. 13. Department of Clinical and Experimental Sciences, University of Brescia, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy.
Abstract
OBJECTIVE: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. DESIGN: Cross-sectional study nested in the 2017 "Delirium Day" project. SETTING AND PARTICIPANTS: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. METHODS: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). RESULTS: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). CONCLUSIONS AND IMPLICATIONS: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.
OBJECTIVE:Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. DESIGN: Cross-sectional study nested in the 2017 "Delirium Day" project. SETTING AND PARTICIPANTS: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. METHODS:Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). RESULTS: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). CONCLUSIONS AND IMPLICATIONS: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.
Authors: A Marengoni; G Bellelli; A Zucchelli; R Apuzzo; C Paolillo; V Prestipino; S De Bianchi; G Romanelli; A Padovani Journal: Aging Clin Exp Res Date: 2021-02-09 Impact factor: 3.636