Predisposing and Precipitating Factors for Delirium in the Very Old (≥80 Years): A Prospective Cohort Study of 3,076 Patients

<b><i>Background:</i></b> Predisposing and precipitating factors for delirium for the elderly, over the age of 65 years, are known, but not for the very old, over 80 years. As the society is getting older and evermore patients will reach &#x3e;80 years, more evidence of the factors and their contribution to delirium is required in this patient group. <b><i>Methods:</i></b> In the course of 1 year, 3,076 patients above 80 years were screened prospectively for delirium based on a Delirium Observation Screening (DOS) scale, Intensive Care Delirium Screening Checklist (ICDSC), and a DSM (Diagnostic and Statistical Manual)-5 nursing instrument (ePA-AC) construct. Relevant predisposing and precipitating factors for delirium were assessed with a multiple regression analysis. <b><i>Results:</i></b> Of 3,076 patients above 80 years, 1,285 (41.8%) developed a delirium, which led to twice prolonged hospitalization (<i>p</i> &#x3c; 0.001), requirement for subsequent assisted living (OR 2.2, CI: 1.73–2.8, <i>p</i> &#x3c; 0.001), and increased mortality (OR 24.88, CI: 13.75–45.03, <i>p</i> &#x3c; 0.001). Relevant predisposing factors were dementia (OR 15.6, CI: 10.17–23.91, <i>p</i> &#x3c; 0.001), pressure sores (OR 4.61, CI: 2.74–7.76, <i>p</i> &#x3c; 0.001), and epilepsy (OR 3.65, CI: 2.12–6.28, <i>p</i> &#x3c; 0.0001). Relevant precipitating factors were acute renal failure (4.96, CI: 2.38–10.3, <i>p</i> &#x3c; 0.001), intracranial hemorrhage (OR 8.7, CI: 4.27–17.7, <i>p</i> &#x3c; 0.001), and pleural effusions (OR 3.25, CI: 1.77–17.8, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Compared to the general delirium rate of approximately 20%, the prevalence of delirium doubled above the age of 80 years (41.8%) due to predisposing factors uncommon in younger patients.

The Delirium Observation Screening Scale: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy

Delirium is a reversible impairment of metabolism in the human brain. Early detection is important, and an effective screening tool for nurses is crucial. The Delirium Observation Screening (DOS) scale is one such screening tool; however, its diagnostic test accuracy has not yet been thoroughly examined. This study, therefore, aimed to evaluate the accuracy of the scale through a systematic review and meta-analysis. In July 2019, a search was conducted in the MEDLINE, CINAHL, Embase, and PsycARTICLES databases, and following a review against pre-defined eligibility criteria, eight studies were finally included. The quality assessment tool of diagnostic accuracy studies was applied to each study and a hierarchical regression model was used to calculate the pooled estimates of sensitivity (90%; 76%–97%, CI 95%) and specificity (92%; 88%–94%, CI 95%). The findings indicated a high diagnostic test accuracy for the DOS scale.

The prevalence rates and adversities of delirium: Too common and disadvantageous

Objective The prevalence rates and adversities of delirium have not yet been systematically evaluated and are based on selected populations, limited sample sizes, and pooled studies. Therefore, this study assesses the prevalence rates and outcome of and odds ratios for managing services for delirium. Methods In this prospective cohort study, based on the Diagnostic and Statistical Manual (DSM) 5, the Delirium Observation Screening (DOS) scale, and the Intensive Care Delirium Screening Checklist (ICDSC) construct, 28,118 patients from 35 managing services were included, and the prevalence rates and adverse outcomes were determined by simple logistic regressions and their corresponding odds ratios (ORs). Results Delirious patients were older, admitted from institutions (OR 3.44–5.2), admitted as emergencies (OR 1.87), hospitalized twice longer, and discharged, transferred to institutions (OR 5.47–6.6) rather than home (OR 0.1), or deceased (OR 43.88). The rate of undiagnosed delirium was 84.2%. The highest prevalence rates were recorded in the intensive care units (47.1–84.2%, pooled 67.9%); in the majority of medical services, rates ranged from 20% to 40% (pooled 26.2%), except, at both ends, palliative care (55.9%), endocrinology (8%), and rheumatology (4.4%). Conversely, in surgery and its related services, prevalence rates were lower (pooled 13.1%), except for cardio- and neurosurgical services (53.3% and 46.4%); the lowest prevalence rate was recorded in obstetrics (2%). Significance of results Delirium remains underdiagnosed, and novel screening approaches are required. Furthermore, this study identified the impact of delirium on patients, determined the prevalence rates for 32 services, and elucidated the association between individual services and delirium.

Validating The Düsseldorf Orthorexie Scale (DOS) For Use In Adolescents Aged 14–17

Objectives To determine the face validity of the survey instrument, Düsseldorf Orthorexie Scale (DOS), in adolescents aged 14–17 years. The DOS has been validated for use in adults to identify individuals at-risk for symptoms and behaviors consistent with the condition of Orthorexia Nervosa (ON). This condition is characterized by a pathological obsession with healthy or “clean” eating which leads to psychological and physical impairment. Methods Researchers conducted seven focus groups with male and female students currently enrolled in a high school health class (n = 40; 11 males, 29 females aged 14–17). Participants first completed the DOS scale and then were asked to participate in a group discussion regarding their understanding of the meaning of the questions in the DOS survey. Focus groups were audio recorded, transcribed, and coded to identify recurring themes. Codes for each of the 10 questions in the DOS scale were analyzed to determine group understanding of key words identified for each question. Results Key words in the original DOS survey questions were in agreement with the codes identified from the transcript of the focus groups for eight of the 10 DOS survey questions. The key words in the other two questions (indulgence in question one and colleague in question seven) were either not understood by focus group population or would need to be altered due to incorrect or inadequate understanding by focus group participants. 38 participants completed the DOS (M = 18.5, SD = 4.88). 7.9% of participants DOS responses indicated they were at moderate (n = 2) or high (n = 1) risk of practicing orthorexic behavior. Conclusions The DOS scale demonstrated good face validity in an adolescent population and the modification of two questions may improve its face validity. Though our sample was small, results indicate that a sizeable proportion of adolescents may already be practicing orthorexic behaviors. This demonstrates a need for further research to be conducted on effective prevention and intervention strategies for this age group. Funding Sources The author(s) received no financial support for the research, authorship, and/or publication of this article.

The Delirium Observation Screening Scale: A Screening Instrument for Delirium

The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses’ observations during regular care. The scale was tested for content validity by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, α = 0.93 and α = 0.96. Predictive validity against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were Rs -0.79 (p ≤ 0.001) in the hip fracture patients and Rs -0.66 (p ≤ 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse’s ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p ≤ 0.001). Construct validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p ≤ 0.001) in the study with the hip fracture patients and 0.33 (p ≤ 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p ≤ 0.05) in the geriatric medicine patients and -0.55 (p ≤ 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows satisfactory validity and reliability, to guide early recognition of delirium by nurses’ observation.