The Delirium Drug Scale is associated to delirium incidence in the emergency department.

ABSTRACTBackground:The Delirium Drug Scale (DDS) is an evaluation scale developed to assess a patient's drug burden for delirium. The primary goal is to validate the association between the DDS score and the incidence of delirium. METHODS: This study was an observational retrospective cross-sectional chart review study in patients aged 75 years and older. It was carried out in three emergency departments of a tertiary care university health center. Patients were included if a medication list was available. Delirium present upon admission was assessed during the first five days of admission. RESULTS: A total of 1,205 subjects were included in the analysis. The mean age was of 83.4 years, and 62.4% were female. The prevalence of delirium was 19.1%. A total of 745 patients (62%) were exposed to DDS medication. The relative risk for the low (1-2) and high (>2) exposure group according to the DDS score was of 1.26 (CI: 0.95; 1.66) and 2.18 (CI: 1.61; 2.96) compared to a score of 0. In the multivariate analysis, dementia, anxiety, insomnia, history of delirium, infection, and acute kidney failure were significantly associated to delirium. When adjusted for confounding variables, the DDS score was associated with the incidence of delirium with an odd ratio (OR) of 1.29 (CI: 1.16; 1.44). CONCLUSIONS: This study found that DDS score was associated with delirium incidence. The association persisted in the multivariate analysis adjusted for 26 known risks and precipitating factors for delirium.

[STOPP-START: adaptation of a French language screening tool for detecting inappropriate prescriptions in older people]. / STOPP-START: adaptation en langue française d'un outil de détection de la prescription médicamenteuse inappropriée chez la personne agée.

OBJECTIVE: STOPP-START is a screening tool for detecting inappropriate prescriptions in older people. Recently validated in its English-language version, it is a reliable and easy-to-use tool, allowing assessment of prescription drugs often described as inappropriate (STOPP) or unnecessarily underused (START) in this population. An adaptation of the tool into French language is presented here. METHOD: A translation-back translation method, with validation of the obtained version by French-speaking experts from Belgium, Canada, France and Switzerland, has been used. An inter-rater reliability analysis completed the validation process. Fifty data sets of patients hospitalized in an academic geriatrics department (mean age +/- standard deviation: 77.6 +/- 7.9 years; 70% were women) were analyzed independently by one geriatrician and one general practitioner. RESULTS: The adaptation in French considers the 87 STOPP-START criteria of the original version. They are all organized according to physiological systems. The 50 data sets involved 418 prescribed medications (median 8; inter-quartile range 5-12). The proportions of positive and negative inter-observer agreements were 99% and 95% respectively for STOPP, and 99% and 88% for START; Cohen's kappa-coefficients were 0.95 for STOPP and 0.92 for START. These results indicated an excellent inter-rater agreement. CONCLUSION: Therefore, this French language version of STOPP-START is as reliable as the original English language version of the tool. For STOPP-START to have tangible clinical benefit to patients, a randomized controlled trial must be undertaken to demonstrate efficacy in the prevention of adverse clinical events connected with inappropriate prescriptions.

[Validation of indicators of the management of cognitive impairment in geriatric assessment units]. / Validation d'indicateurs de la prise en charge des atteintes des fonctions cognitives dans les unités d'évaluation gériatrique.

OBJECTIVE: To analyze and adapt a set of quality indicators for assessment and management of patients with cognitive disorders, which are seen very frequently in geriatric assessment units in Quebec. DESIGN: Modified Delphi technique. SETTING: Province of Quebec. PARTICIPANTS: Seven clinicians from 3 different medical faculties in Quebec were selected for their expertise in dementia and geriatric care. METHOD: From among the indicators developed in 2001 using the RAND method, 22 items selected for their relevance to evaluation and management of cognitive disorders were adapted to clinical practice in the Quebec hospital system. These indicators, along with evidence from the literature, were submitted by mail to a panel of experts. The experts were asked to rate, on a scale of 1 to 9, their level of agreement with the indicators in terms of their validity and quality and the need for them to be recorded in patients' medical charts. For an indicator to be retained, it had to be accepted according to its median value, to be rated in the upper third of the scale, and to be approved by the panelists. Indicators not accepted at first were modified according to experts' comments and then re-submitted to the same panel for a second round. RESULTS: Of 22 indicators submitted in the first round, 21 were validated. They covered assessment, investigation, evaluation, treatment, and follow-up. The indicator found questionable was modified and then accepted during the second round. CONCLUSION: This study identified 22 indicators relevant to assessment and management of patients with cognitive disorders in geriatric assessment units. These indicators will serve as a basis for evaluation of dementia in a larger study of the quality of care in all short-term geriatric assessment units in Quebec.