What prompts patients to present with delirium?

PURPOSE: To explore the recognition, response and understanding of delirium in families and carers of hospitalised patients. METHODS: All adults with delirium admitted to an acute medical unit were included. Delirium was diagnosed by a specialist geriatrician. The responder who sought medical advice for each patient was interviewed using a delirium recognition questionnaire. Vital status was ascertained at four months. RESULTS: Sixty patients were included (mean age 85, SD 6.8 years). Reported symptoms included drowsiness and lack of responsiveness, though these were less commonly recognised as being due to delirium. 76% received medical advice within 24 h, although two responders took > 1 week. One-third of responders had never heard of delirium. Delirium knowledge among responders was variable. CONCLUSION: Overall awareness and knowledge of delirium was poor. Community delirium education and public health initiatives may improve rapidity of recognition, delirium assessment, and potentially health outcomes.

The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study.

INTRODUCTION: Delirium is associated with a wide range of adverse patient safety outcomes, yet it remains consistently under-diagnosed. We undertook a systematic review of studies describing delirium in adult medical patients in secondary care. We investigated if changes in healthcare complexity were associated with trends in reported delirium over the last four decades. METHODS: We used identical criteria to a previous systematic review, only including studies using internationally accepted diagnostic criteria for delirium (the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases). Estimates were pooled across studies using random effects meta-analysis, and we estimated temporal changes using meta-regression. We investigated publication bias with funnel plots. RESULTS: We identified 15 further studies to add to 18 studies from the original review. Overall delirium occurrence was 23% (95% CI 19-26%) (33 studies) though this varied according to diagnostic criteria used (highest in DSM-IV, lowest in DSM-5). There was no change from 1980 to 2019, nor was case-mix (average age of sample, proportion with dementia) different. Overall, risk of bias was moderate or low, though there was evidence of increasing publication bias over time. DISCUSSION: The incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may have masked true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.