Precipitating factors associated with delirium among long-term care residents with dementia.

This cross-sectional study (N = 155) investigated precipitating factors associated with delirium among long-term-care residents with dementia and assessed their cumulative effect on the likelihood of having delirium. Use of physical restraints (odds ratio [OR] = 4.64, 95% confidence interval [CI] = 2.61-8.27) was the factor most associated, and the likelihood of being in delirium increased with the number of associated precipitating factors present (OR = 2.53, 95% CI = 1.42-4.49). Given their frailty, only a few precipitating factors need be present to increase the likelihood of these residents being in delirium, hence the need for increased nurse awareness of the risks posed by use of physical restraints with respect to the cognitive function of elderly residents with dementia.

Examination of the multifactorial model of delirium among long-term care residents with dementia.

The multifactorial model of delirium was developed to explain the interrelationship between predisposing and precipitating factors for delirium. Although validated among hospitalized patients, this model has never been tested among long-term care residents with dementia. We undertook this secondary data analysis to investigate the combined effect of predisposing and precipitating factors on the likelihood of having delirium among this population. Delirium was defined as meeting the Confusion Assessment Method criteria for definite or probable delirium. Risk factors considered in the study were those found significantly associated with delirium in the original study. Participants (N=155) were classified into risk groups. Prevalence of delirium for the low, moderate, and high predisposing risk groups were 32%, 78.4%, and 98.1%, respectively, and 37.9%, 67.2%, and 86.8% for the precipitating factors risk groups. When both variables were included in the same model, only predisposing factors remained statistically associated with delirium. Predisposing factors play a key role in the likelihood of having delirium among this population. Increased awareness of these factors among nurses could improve the care of these residents by targeting modifiable risk factors.

[Detection of delirium by nurses]. / Le dépistage du délirium par les infirmières.

The purpose of this study was to determine to what extent nurses practising in long-term care settings are able to detect delirium among elderly clients. This was a prospective clinical study, with two measurements taken seven days apart. The population studied consisted of 156 elderly people with dementia, and 32 nurses. The findings showed that these nurses had difficulty detecting delirium in this clientele. Their detection sensitivity varied from 7.3% to 15.5% and its specificity ranged from 95.2% to 100%. The probability of detection was higher when the elderly person experienced pain accompanied by delirium. For clients' well-being and the credibility of the profession, it appears crucial that steps be taken immediately to enable nurses to become fully competent in assessing seniors' mental states. Training in the clinical examination of mental states, clinical mentoring and the integration of an assessment tool into nursing practice are among the means suggested.

Partial normalization of the heart rate response to exercise after cardiac transplantation: frequency and relationship to exercise capacity.

OBJECTIVE: To determine the frequency of partial normalization of the heart rate response to graded exercise and its relationship to exercise capacity in cardiac transplant recipients. SUBJECTS AND METHODS: The study subjects were 95 adults (77 men, 18 women) who were available to perform a cardiopulmonary exercise test 1 year after orthotopic cardiac transplantation, which occurred between June 1988 and September 1998. All subjects received standard immunosuppressant medications. At the time of the exercise tests, the mean +/- SD age of the subjects was 49+/-14 years. The mean +/- SD resting left ventricular ejection fraction was 62%+/-8%. All subjects participated in a 6- to 8-week supervised exercise program, starting no later than 1 month after surgery. Subjects were given an exercise prescription for independent exercise training after finishing the supervised program. Self-reported weekly exercise training had a median value of 90 minutes (interquartile range, 0-210 minutes). Symptom-limited graded exercise was performed on a treadmill, with breath-by-breath analysis of expired air. RESULTS: For the entire cohort, peak exercise oxygen uptake was 19.9+/-4.8 mL x kg(-1) x min(-1) (61%+/-15% of age and sex predicted). Thirty-two subjects (34%) had a partially normalized heart rate response to graded exercise. The frequency was similar for men (25/77 [33%]) and for women (7/18 [39%]) and was independent of recipient or donor age. Peak exercise heart rate (147+/-18 vs 134+/-21 beats/min; P=.008) and heart rate reserve (46+/-15 vs 33+/-15 beats/min; P<.001) were greater for subjects with a partial normalization of heart rate response. Peak exercise oxygen uptake was similar for subjects with or without partial normalization of the heart rate response (20.9+/-5.8 vs 19.4+/-4.2 mL x kg(-1) x min(-1); P=.22). Submaximal exercise oxygen uptake during the first few minutes of exercise was also not affected by normalization of the heart rate response. CONCLUSION: At 1 year after cardiac transplantation, approximately one third of subjects had partial normalization of the heart rate response to graded exercise. However, a higher peak exercise heart rate and a larger heart rate reserve did not result in better aerobic exercise capacity.