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Open Access Research article

Detection of delirium by nurses among long-term care residents with dementia

Philippe Voyer1*, Sylvie Richard2, Lise Doucet3, Christine Danjou4 and Pierre-Hugues Carmichael5

Author Affiliations

1 Faculty of Nursing, Laval University, Quebec City, Canada

2 Laval University Geriatric Research Unit, St-Sacrement Hospital Centre, Quebec City, Canada

3 Long-term care department, Centre de santé et de services sociaux de la Vieille-Capitale, Quebec City, Canada

4 Faculty of Nursing, Laval University, Quebec City, Canada

5 Center for Excellence in Aging, St-Sacrement Hospital Centre, Quebec City, Canada

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BMC Nursing 2008, 7:4  doi:10.1186/1472-6955-7-4

Published: 26 February 2008

Abstract

Background

Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium.

Methods

In this prospective study (N = 156), nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses.

Results

Despite a high prevalence of delirium in this cohort (71.5%), nurses were able to detect the delirium in only a minority of cases (13%). Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (≥ 85 yrs) was associated with undetected delirium (OR: 4.1; 90% CI: [1.5–11.0]).

Conclusion

Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population.