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Stability of Postoperative Delirium Psychomotor Subtypes in Individuals with Hip Fracture
Author(s) -
Albrecht Jennifer S.,
Marcantonio Edward R.,
Roffey Darren M.,
Orwig Denise,
Magaziner Jay,
Terrin Michael,
Carson Jeffrey L.,
Barr Erik,
Brown Jessica P.,
Gentry Emma G.,
GruberBaldini Ann L.
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13334
Subject(s) - psychomotor learning , delirium , medicine , hip fracture , psychomotor agitation , prospective cohort study , incidence (geometry) , psychomotor disorder , cognition , physical therapy , anesthesia , psychiatry , physics , osteoporosis , optics
Objectives To determine the stability of psychomotor subtypes of delirium over time and identify characteristics associated with delirium psychomotor subtypes in individuals undergoing surgical repair of hip fracture. Design Prospective cohort study. Setting The Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair Cognitive Ancillary Study was conducted at 13 participating sites from 2008 to 2009. Participants Individuals who had undergone surgical repair of hip fracture (N = 139). Measurements Delirium was assessed up to four times postoperatively using the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale. Psychomotor subtypes of delirium were categorized as hypoactive, hyperactive, mixed, and normal psychomotor activity. Results Incidence of postoperative delirium was 41% (n = 57). Of 90 CAM–positive (CAM+) observations, 56% were hypoactive, 10% were hyperactive, 21% were mixed, and 14% had normal psychomotor symptoms. Of 26 participants with more than one CAM+ assessment, 50% maintained subtype stability over time. Participants with hypoactive or normal psychomotor symptoms (n = 31) were less likely to have chart documentation of delirium than participants with any hyperactive symptoms (n = 19) (22% vs 58%, P = .009). Conclusion Psychomotor subtypes of delirium often fluctuate from assessment to assessment, rather than representing fixed categories of delirium. Hypoactive delirium is the most common presentation of delirium but is the least likely to be documented by healthcare providers.