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Acute confusional state in elderly orthopaedic patients: factors of importance for detection in nursing care
Author(s) -
Andersson Edith M.,
Gustafson Lars,
Hallberg Ingalill R.
Publication year - 2001
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/1099-1166(200101)16:1<7::aid-gps261>3.0.co;2-w
Subject(s) - medicine , incidence (geometry) , hazard ratio , delirium , confusion , emergency medicine , pediatrics , intensive care medicine , confidence interval , psychology , physics , psychoanalysis , optics
Objectives The aims of this study were to identify factors of significance in the development of acute confusional state (ACS) and the differences between patients who developed ACS and those who did not. Method and Results Assessment, observations and interviews with 505 patients admitted to an orthopaedic clinic revealed that 51 patients developed ACS during their in‐hospital stay. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthros or gonarthros (3.6%). The highest hazard ratio for ACS was several other physical diseases 15.94 (CI: 4.60–55.31 and p ‐value <0.00001) and the lowest was age 1.10 (CI: 1.04–1.15 and p ‐value <0.0002). The ACS lasted from 1 to 9 days, and patients had one ( N =42), two ( N =8) or three episodes ( N =1) of confusion during their stay on the ward. More patients who developed ACS before surgery had two or more confusional episodes and emergency patients developed ACS more rapidly. The ACS lasted longer in patients with a higher score on the OBS scale at admittance and with rapid development of ACS. Conclusions Acuteness in the situation seems an important risk indication for ACS in the elderly. Awareness of factors associated with the development of ACS makes it possible to more systematically identify those at risk, for instance by systematic assessment in the first interview with the patient on admission to hospital. Copyright © 2001 John Wiley & Sons, Ltd.