Development of a delirium risk screening tool for long-term care facilities

International Journal of Geriatric Psychiatry, 05/07/2012

This brief screening tool allows nurses to identify long–term care residents at increased risk for delirium. These residents can be targeted for closer monitoring and preventive interventions.

Methods

  • The sample comprised residents aged 65 years and over of seven LTC facilities in Montreal and Quebec City, Canada, admitted for LTC.
  • Primary analyses were conducted among residents without delirium at baseline.
  • Incident delirium was diagnosed using multiple data sources during the 6-month follow-up.
  • Risk factors, all measured at or prior to baseline, included the following six groups: sociodemographic, medical, cognitive status, physical function, agitated behavior, and symptoms of depression.
  • Variables were analyzed individually and by group using Cox regression models.
  • Clinical judgment was used to select the most feasible among similarly performing factors.

Results

  • The cohort comprised 206 residents without delirium at baseline; 69 cases of incident delirium were observed (rate 7.6 per 100 person weeks).
  • The best-performing screening tool comprised five items, with an overall area under the curve of 0.82 (95% CI 0.76, 0.88).
  • These items included brief measures of cognitive status, physical function, behavioral, and emotional problems.
  • Using cut-points of 2 (or 3) over 5, the scale has a sensitivity of 90% (63%), specificity of 59% (85%), and positive predictive value of 52% (66%).

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