Comparison between Delirium Screening Tools among Elderly Patients Admitted to Ain Shams University Hospitals

Abstract

Delirium is a significant health problem with considerable social and economic impact and one of the most distressing syndromes for those affected and their caregivers. Delirium is independently associated with significant increase in the functional impairment, length of hospital stay, inpatient mortality, long term mortality, cognitive decline, requirement for institutional care, functional impairment. Our study was a case-control study which included 140 Egyptian elderly patients. Seventy patients with delirium (cases) and seventy patients without delirium (controls) admitted to Geriatric Hospital, Ain Shams University to determine the validity of CAM-long form, 4A test, NUDESC and MOTYB for delirium screening versus the reference standard (DSM-V) criteria as diagnostic tool and to determine the length of hospital stay relative to the initial scores of delirium screening tools. All participants underwent structured interview questionnaire which included detailed socio-demographic data, past medical history with special focus on dementia using The Informant Questionnaire of Cognitive Decline in the Elderly- Short form (IQCODE-SF), delirium, depression, TIA and previous cerebrovascular strokes as well as doing general and local examination. Advanced age, male gender, past history of stroke, DM and falls were found to be significant risk factors for delirium. The most common direct causes of delirium were metabolic causes (28.6%), followed by hepatic encephalopathy (22.9 %), infections (21.43%) and multi-factorial causes (15.7%). Regarding sensitivity for delirium screening, CAM- long form is the most sensitive tool (100%) followed by 4A test (94.29%), NUDESC (88.57%) and the least sensitive one is MOTYB (72.68%). CAM- long form consists of major nine delirium criteria including observational and interactive items which makes it very sensitive for delirium screening but it requires special training before its use for optimum results.