Alessandro Morandi1,2,3,4, Giuseppe Bellelli5,6, Chiara Sidoli5, Antonella Zambon7,8, Elena Tassistro9, Emanuela Rossi9, Enrico Mossello10,11, Marco Inzitari12, Antonio Cherubini13, Alessandra Marengoni14. 1. Department of Rehabilitation, Azienda Speciale di Cremona Solidale, A.S.C.S., Cremona, Italy. morandi.alessandro@gmail.com. 2. Geriatric Research Group, Brescia, Italy. morandi.alessandro@gmail.com. 3. REFiT Bcn research group, Parc Sanitari Pere Virgili and Vall d'Hebrón Institut de Recerca (VHIR), Barcelona, Spain. morandi.alessandro@gmail.com. 4. Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, TN, USA. morandi.alessandro@gmail.com. 5. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 6. Acute Geriatric Unit, San Gerardo hospital, Monza, Italy. 7. Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy. 8. Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy. 9. Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 10. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 11. Division of Geriatric and Intensive Care Medicine, AOU Careggi, Florence, Italy. 12. Intermediate Care, Research and Teaching, Parc Sanitari Pere Virgili, Barcelona, Spain. 13. Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy. 14. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Abstract
BACKGROUND: Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM: We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS: We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS: Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION: This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
BACKGROUND: Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM: We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS: We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS: Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION: This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
Authors: Enrico Mossello; Francesca Tesi; Simona G Di Santo; Andrea Mazzone; Monica Torrini; Antonio Cherubini; Mario Bo; Massimo Musicco; Angelo Bianchetti; Alberto Ferrari; Nicola Ferrara; Marco Trabucchi; Alessandro Morandi; Giuseppe Bellelli Journal: J Am Geriatr Soc Date: 2017-12-05 Impact factor: 5.562
Authors: Alessandro Morandi; Simona G Di Santo; Antonella Zambon; Andrea Mazzone; Antonio Cherubini; Enrico Mossello; Mario Bo; Alessandra Marengoni; Angelo Bianchetti; Stefano Cappa; Filippo Fimognari; Raffaele Antonelli Incalzi; Pietro Gareri; Francesco Perticone; Mauro Campanini; Italo Penco; Marco Montorsi; Mauro Di Bari; Marco Trabucchi; Giuseppe Bellelli Journal: J Gerontol A Biol Sci Med Sci Date: 2019-05-16 Impact factor: 6.053
Authors: Alessandro Morandi; Andrea Mazzone; Bruno Bernardini; Teresa Suardi; Roberto Prina; Christian Pozzi; Simona Gentile; Marco Trabucchi; Giuseppe Bellelli Journal: Geriatr Gerontol Int Date: 2019-02-20 Impact factor: 2.730
Authors: Joost Witlox; Lisa S M Eurelings; Jos F M de Jonghe; Kees J Kalisvaart; Piet Eikelenboom; Willem A van Gool Journal: JAMA Date: 2010-07-28 Impact factor: 56.272
Authors: Jo Ellen Wilson; Matthew F Mart; Colm Cunningham; Yahya Shehabi; Timothy D Girard; Alasdair M J MacLullich; Arjen J C Slooter; E Wesley Ely Journal: Nat Rev Dis Primers Date: 2020-11-12 Impact factor: 65.038
Authors: Giuseppe Bellelli; Alessandro Morandi; Simona G Di Santo; Andrea Mazzone; Antonio Cherubini; Enrico Mossello; Mario Bo; Angelo Bianchetti; Renzo Rozzini; Ermellina Zanetti; Massimo Musicco; Alberto Ferrari; Nicola Ferrara; Marco Trabucchi Journal: BMC Med Date: 2016-07-18 Impact factor: 8.775