scholarly journals How to deal with the consent of adults with cognitive impairment involved in European geriatric living labs?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Guillaume Sacco ◽  
Frédéric Noublanche ◽  
Frédéric Blazek ◽  
Catherine Hue ◽  
Loïc Carballido ◽  
...  
Keyword(s):  
Older Adults ◽  
Ethical Issues ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Interview ◽  
Neurocognitive Disorders ◽  
Design Development ◽  
Capacity To Consent ◽  
Wide Range ◽  
Living Labs

Abstract Background Living labs are realistic environments designed to create links between technology developers and end-users (i.e. mostly older adults). Research in LLH (Living labs in health) covers a wide range of studies from non-interventional studies to CT (clinical trials) and should involve patients with neurocognitive disorders. However, the ethical issues raised by the design, development, and implementation of research and development projects in LLH have been the subject of only little interest thus far. Objective Our aim was to determine a pragmatic, ethical and regulatory correct approach to seek the informed consent of patients with neurocognitive disorders according to the different types of studies carried out in European LLH, with a focus on the French context. Methods A narrative review of regulatory texts and clinical articles was conducted, and a pragmatic procedure to determine the decision-making capacity of older adults in LLH was proposed. Results Individuals must be adequately informed and freely agree to participate in CT. The capacity to consent should be assessed in CT including cognitively impaired older adults. We propose the following steps: first to assess for delirium using the 4 ‘A’s Test (4AT) or the 3-min Diagnostic interview for Confusion Assessment Method (3D-CAM), second to search for medical history of major neurocognitive disorder, and third to assess the decision capacity using the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). Conclusions Including individuals with neurocognitive disorders in research implies using an efficient and pragmatic strategy to inform participants and obtain their consent. The tool we offer here may be useful in the routine operation of LLH but can also be extended to all CT with this population.

3-Minute Diagnostic Interview for Confusion Assessment Method--Chinese Version

2020 ◽  
Author(s):  
Dong-Liang Mu ◽  
Pan-Pan Ding ◽  
Shu-Zhe Zhou ◽  
Mei-Jing Liu ◽  
Xin-Yu Sun ◽  
...  
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Interview ◽  
Chinese Version ◽  
Confusion Assessment

scholarly journals The Effect of Multiple Assessments on Delirium Detection: a Pilot Study*

2020 ◽  
Vol 23 (4) ◽  
pp. 277-282
Author(s):  
SA. De Freitas ◽  
EKC. Wong ◽  
JY. Lee ◽  
C. Reppas-Rindlisbacher ◽  
C. Gabor ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hip Fractures ◽  
Detection Rate ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Interview ◽  
Academic Hospital ◽  
Confusion Assessment ◽  
High Prevalence ◽  
Orthopaedic Ward

Background Delirium is characterized by fluctuating attention or arousal, with high prevalence in the orthopaedic ward. Our aim was to: 1) establish the prevalence of delirium on an orthopaedic ward, and 2) compare delirium prevalence using a single geriatrician assessment vs. multiple 3D-CAM (3-Minute Diagnostic Interview for Confusion Assessment Method) assessments during the day. We hypothesized that multiple assessments would increase the detection rate due to the fluctuating nature of delirium. Methods Comparative study conducted at an academic hospital in Hamilton, Ontario. Participants included patients 65 years and older admitted to the orthopaedic ward (n=55). After a geriatrician made the first assessment of delirium by 3D-CAM on each patient, teams with specialized geriatrics training re-assessed participants up to four times. Delirium rates based on first assessment were compared to cumulative end-of-day rates to determine if detection increased with multiple assessments. Results The prevalence of delirium was 30.9% (17 participants) us­ing multiple assessments. Of these cases, 13 (76.4%) were detected in the initial geriatrician assessment. In patients with hip fractures, 70.6% (12 of 17) were identified as delirious by multiple assessments. Conclusion As symptoms fluctuate, multiple daily CAM assessments may increase the identification of delirium in orthopaedic inpatients.

scholarly journals Ultrabrief Screens for Detecting Delirium in Postoperative Cognitively Intact Older Adults

2020 ◽  
Vol 15 (9) ◽  
pp. 544-547
Author(s):  
Andrea Yevchak Sillner ◽  
Long Ngo ◽  
Yoojin Jung ◽  
Sharon Inouye ◽  
Marie Boltz ◽  
...  
Keyword(s):  
Older Adults ◽  
Postoperative Delirium ◽  
Elective Surgery ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Reference Standard ◽  
Patient Reports ◽  
Confusion Assessment ◽  
Overall Performance ◽  
Cognitively Intact

The authors’ sought to develop an ultrabrief screen for postoperative delirium in cognitively intact patients older than 70 years undergoing major elective surgery. All possible combinations of one-, two- and three-item screens and their sensitivities, specificities, and 95% confidence intervals were calculated and compared with the delirium reference standard Confusion Assessment Method (CAM). Among the 560 participants (mean age, 77 years; 58% women), delirium occurred in 134 (24%). We considered 1,100 delirium assessments from postoperative days 1 and 2. The screen with the best overall performance consisted of three items: (1) Patient reports feeling confused, (2) Months of the year backward, and (3) “Does the patient appear sleepy?” with sensitivity of 92% and specificity of 72%. This brief, three-item screen rules out delirium quickly, identifies a subset of patients who require further testing, and may be an important tool to improve recognition of postoperative delirium.

scholarly journals Pilot Testing of the UB-CAM Delirium Screening App

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 985-985
Author(s):  
Ashley Kuzmik ◽  
John Joseph Hannan ◽  
Long Ngo ◽  
Marie Boltz ◽  
Priyanka Shrestha ◽  
...  
Keyword(s):  
Older Adults ◽  
Rating Scale ◽  
Pragmatic Trial ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Clinical Dementia Rating ◽  
Systematic Screening ◽  
Pilot Testing ◽  
Computer Scientists ◽  
Hospitalized Older Adults

Abstract Systematic screening improves delirium detection among hospitalized older adults. This poster describes the development and pilot testing of an iOS-based app that incorporates the Ultra-Brief Confusion Assessment Method (UB-CAM), a two-step, delirium detection protocol that combines the UB-2 (2-item screener) and 3D-CAM. Previous work tested a RedCAP-based UB-CAM app in 527 patients with 399 physicians, nurses, and certified nursing assistants (CNAs) showing it can be successfully completed by all three disciplines in 97% of eligible patients in 80 seconds on average with over 85% accuracy relative to a gold standard. To improve accessibility to the clinical setting, our research team now collaborated with a computer scientist to develop and refine an iOS-based UB-CAM app for the iPhone and iPad through iterative “laboratory” testing. The app was piloted by non-clinician, research testers in hospitalized older adults (age x̄ =83, SD= 8.0) with dementia (Clinical Dementia Rating Scale x̄ =1.1, SD= .30); 64% were assessed to be delirium positive. The app demonstrated preliminary efficiency (90 seconds on average), high acceptability (100% satisfaction of users), and reliability (100% inter-rater). This project underscores the need for close collaboration between researchers, clinicians, and computer scientists with iterative testing of bedside-facing apps prior to testing with patients. Next steps include testing effectiveness in a pragmatic trial with clinician users (physicians, nurses, CNAs), integrating the UB-CAM app into the routine hospital care of all older patients. Having rapid, accurate bedside delirium detection has the potential to transform care.

scholarly journals Stakeholder Requirements for an Ethical Framework to Sustain Multiple Research Projects in an Emerging Living Lab Involving Older Adults

2019 ◽  
Vol 15 (3) ◽  
pp. 111-127
Author(s):  
Tiziana C. Callari ◽  
Louise Moody ◽  
Janet Saunders ◽  
Gill Ward ◽  
Julie Woodley
Keyword(s):  
Older Adults ◽  
Ethical Issues ◽  
Ethical Framework ◽  
User Engagement ◽  
Ethical Challenges ◽  
Design Development ◽  
Structured Interviews ◽  
Ethical Guidelines ◽  
Living Lab ◽  
Research Initiatives

Living Lab (LL) research should follow clear ethical guidelines and principles. While these exist in specific disciplinary contexts, there is a lack of tailored and specific ethical guidelines for the design, development, and implementation of LL projects. As well as the complexity of these dynamic and multi-faceted contexts, the engagement of older adults, and adults with reducing cognitive and physical capacity in LL research, poses additional ethical challenges. Semi-structured interviews were undertaken with 26 participants to understand multistakeholder experiences related to user engagement and related ethical issues in emerging LL research. The participants’ experiences and concerns are reported and translated into an ethical framework to guide future LL research initiatives.

scholarly journals The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome

Geriatrics ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. 57 ◽  
Author(s):  
Hewitt ◽  
Owen ◽  
Carter ◽  
Stechman ◽  
Tay ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Ageing Population ◽  
Multi Centre Study ◽  
Logistic Regression Models ◽  
Surgical Units

Background: With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). Objectives: To establish the prevalence of delirium on admission in an older acute surgical population and its effect on mortality. Secondary outcomes investigated include hospital readmission and length of hospital stay. Method: This observational multi-centre study investigated consecutive patients, ≥65 years, admitted to the acute surgical units of five UK hospitals during an eight-week period. On admission the Confusion Assessment Method (CAM) score was performed to detect delirium. The effect of delirium on important clinical outcomes was investigated using tests of association and logistic regression models. Results: The cohort consisted of 411 patients with a mean age of 77.3 years (SD 8.1). The prevalence of admission delirium was 8.8% (95% CI 6.2–11.9%) and cognitive impairment was 70.3% (95% CI 65.6–74.7%). The delirious group were not more likely to die at 30 or 90 days (OR 1.1, 95% CI 0.2 to 5.1, p = 0.67; OR 1.4, 95% CI 0.4 to 4.1. p = 0.82) or to be readmitted within 30 days of discharge (OR 0.9, 95% CI 0.4 to 2.2, p = 0.89). Length of hospital stay was significantly longer in the delirious group (median 8 vs. 5 days respectively, p = 0.009). Conclusion: Admission delirium occurs in just under 10% of older people admitted to acute surgical units, resulting in significantly longer hospital stays.

3-Minute Diagnostic Interview for Confusion Assessment Method

2014 ◽  
Author(s):  
Edward R. Marcantonio ◽  
Long H. Ngo ◽  
Margaret O'Connor ◽  
Richard N. Jones ◽  
Paul K. Crane ◽  
...  
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Interview ◽  
Confusion Assessment

Post-operative delirium in older patients following cancer related and other high-risk surgeries.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24024-e24024
Author(s):  
Rawad Elias ◽  
Ilene Staff ◽  
Stephen Thompson ◽  
Christine Waszynski ◽  
Jennifer Zanchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Logistic Regression ◽  
High Risk ◽  
Tertiary Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Chi Square ◽  
Targeted Interventions ◽  
Increased Risk

e24024 Background: Older adults are at increased risk for postoperative delirium (POD). This risk might be higher in patients with cancer as underlying malignancy and its complications predispose individuals to develop delirium. Therefore, it is important to evaluate the onset of delirium in this patient population especially as POD is associated with increased risk of rehospitalization, decline in cognitive function, morbidity and mortality. Methods: We performed a retrospective review of patients aged ≥ 70 years admitted January 2017 through July 2019 to a tertiary care referral center for a high-risk surgery, defined as associated with a mortality risk greater than 1%. Cancer related surgeries (CRS) were identified through cross matching with Cancer Registry. Patients who had delirium assessment in the postoperative setting using the Confusion Assessment Method (CAM) were included. Chi-square tests of proportion, Wilcoxon Ranked Sum and multivariate logistic regression analyses were conducted. Results: A total of 2340 patients were included in this analysis, 315 of whom had (CRS). Overall, the age (median, IQR) of patients at surgery was 76 years (72-80) and the length of stay (LOS) was 7 (4-11) days. Patients receiving CRS were younger (75, 72-79) than those with non-CRS (76, 72-81) (p = 0.022); had a shorter post-operative LOS (4, 2-7 vs. 5, 3-8; p > 0.001), and were less likely to develop POD (7.6% vs. 16.1%; p < 0.001). Among patients receiving CSR, those who developed POD were older (78 vs. 74; p = 0.008) and had longer post-operative LOS (14.0 vs. 4.0; p < 0.001). Those having experienced radiotherapy (RT) for cancer within the year before the surgery, were more likely to develop POD (40.0% vs. 6.6% p. < 0.001). Chemotherapy in the year prior to surgery did not increase the risk of POD (6.1% vs. 7.8%; p = 0.721). Among those having non-CRS, a cancer diagnosis did not affect POD. A logistic regression predicting POD indicated that the lower likelihood of POD following CRS was independent of age or gender (OR = 0.40; p < .001); RT within one year prior was independent predictor of higher POD (OR = 5.48; p = 0.003). Our data presentation will include further analysis of POD risk factors. Conclusions: Although older adults receiving CRS were significantly less likely to develop delirium than patients with other high-risk surgeries, it is still important to evaluate POD in this population due to its impact of patients’ outcomes. Further understanding of POD risk factors, such as preoperative RT, would allow the development of targeted interventions that might lessen the risk.

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery

2019 ◽  
Vol 42 (3) ◽  
pp. 165-176 ◽  
Author(s):  
Dawn L. Denny ◽  
Glenda N. Lindseth
Keyword(s):  
Older Adults ◽  
Joint Replacement ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Status ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Subsyndromal Delirium ◽  
Preoperative Risk Factors ◽  
Statistical Relationships

This study examined the effects of pain and opioid intakes on subsyndromal delirium in older adults who had joint replacement surgery. Delirium assessments of 53 older adults were completed on the first, second, and third days following joint replacement surgery using the Confusion Assessment Method (CAM). Statistical relationships were analyzed using correlations and multiple regressions. Subsyndromal delirium developed in 68% ( n = 36) of participants. Pain was significantly related ( p < .05) to increased delirium symptoms after accounting for preoperative risk factors of comorbidity, cognitive status, fall history, and preoperative fasting times, whereas opioid intake was not significantly associated with increased delirium symptoms. Findings suggest older adults with increased pain levels are at higher risk for subsyndromal delirium as well as delirium after joint replacement surgery.

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