Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study.

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

Data di pubblicazione: 2021
Titolo: Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study.
Autori: Morandi, A; Inzitari, M; Udina, C; Gual, N; Mota, M; Tassistro, E; Andreano, A; Cherubini, A; Gentile, S; Mossello, E; Marengoni, A; Olivé, A; Riba, F; Ruiz, D; de Jaime, E; Bellelli, G; Tarasconi, A; Sella, M; Auriemma, S; Paternò, G; Faggian, G; Lucarelli, C; De Grazia, N; Alberto, C; Margola, A; Porcella, L; Nardiello, I; Chimenti, E; Zeni, M; Giani, A; Famularo, S; Romairone, E; Minaglia, C; Ceccotti, C; Guerra, G; Mantovani, G; Monacelli, F; Minaglia, C; Candiani, T; Ballestrero, A; Minaglia, C; Santolini, F; Minaglia, C; Rosso, M; Bono, V; Sibilla, S; Dal Santo, P; Ceci, M; Barone, P; Schirinzi, T; Formenti, A; Nastasi, G; Isaia, G; Gonella, D; Battuello, A; Casson, S; Calvani, D; Boni, F; Ciaccio, A; Rosa, R; Sanna, G; Manfredini, S; Cortese, L; Rizzo, M; Prestano, R; Greco, A; Lauriola, M; Gelosa, G; Piras, V; Arena, M; Cosenza, D; Bellomo, A; LaMontagna, M; Gabbani, L; Lambertucci, L; Perego, S; Parati, G; Basile, G; Gallina, V; Pilone, G; Giudice, C; De, F; Pietrogrande, L; De, B; Mosca, M; Corazzin, I; Rossi, P; Nunziata, V; D'Amico, F; Grippa, A; Giardini, S; Barucci, R; Cossu, A; Fiorin, L; Arena, M; Distefano, M; Lunardelli, M; Brunori, M; Ruffini, I; Abraham, E; Varutti, A; Fabbro, E; Catalano, A; Martino, G; Leotta, D; Marchet, A; Dell'Aquila, G; Scrimieri, A; Davoli, M; Casella, M; Cartei, A; Polidori, G; Basile, G; Brischetto, D; Motta, S; Saponara, R; Perrone, P; Russo, G; Del, D; Car, C; Pirina, T; Franzoni, S; Cotroneo, A; Ghiggia, F; Volpi, G; Menichetti, C; Bo, M; Panico, A; Calogero, P; Corvalli, G; Mauri, M; Lupia, E; Manfredini, R; Fabbian, F; March, A; Pedrotti, M; Veronesi, M; Strocchi, E; Borghi, C; Bianchetti, A; Crucitti, A; DiFrancesco, V; Fontana, G; Bonanni, L; Barbone, F; Serrati, C; Ballardini, G; Simoncelli, M; Ceschia, G; Scarpa, C; Brugiolo, R; Fusco, S; Ciarambino, T; Biagini, C; Tonon, E; Porta, M; Venuti, D; DelSette, M; Poeta, M; Barbagallo, G; Trovato, G; Delitala, A; Arosio, P; Reggiani, F; Zuliani, G; Ortolani, B; Mussio, E; Girardi, A; Coin, A; Ruotolo, G; Castagna, A; Masina, M; Cimino, R; Pinciaroli, A; Tripodi, G; Cannistrà, U; Cassadonte, F; Vatrano, M; Scaglione, L; Fogliacco, P; Muzzuilini, C; Romano, F; Padovani, A; Rozzini, L; Cagnin, A; Fragiacomo, F; Desideri, G; Liberatore, E; Bruni, A; Orsitto, G; Franco, M; Bonfrate, L; Bonetto, M; Pizio, N; Magnani, G; Cecchetti, G; Longo, A; Bubba, V; Marinan, L; Cotelli, M; Turla, M; Brunori, M; Sessa, M; Abruzzi, L; Castoldi, G; LoVetere, D; Musacchio, C; Novello, M; Cavarape, A; Bini, A; Leonardi, A; Seneci, F; Grimaldi, W; Seneci, F; Fimognari, F; Bambara, V; Saitta, A; Corica, F; Braga, M; Ettorre, E; Camellini, C; Bellelli, G; Annoni, G; Marengoni, A; Bruni, A; Crescenzo, A; Noro, G; Turco, R; Ponzetto, M; Giuseppe, L; Mazzei, B; Maiuri, G; Costaggiu, D; Damato, R; Fabbro, E; Formilan, M; Patrizia, G; Gallucci, M; Minaglia, C; Paragona, M; Bini, P; Modica, D; Abati, C; Clerici, M; Barbera, I; NigroImperiale, F; Manni, A; Votino, C; Castiglioni, C; Di, M; Degl'Innocenti, M; Moscatelli, G; Guerini, S; Casini, C; Dini, D; D'Imporzano, E; DeNotariis, S; Bonometti, F; Paolillo, C; Riccardi, A; Tiozzo, A; Riccardi, A; Paolillo, C; DiBari, M; Vanni, S; Scarpa, A; Zara, D; Ranieri, P; Alessandro, M; Calogero, P; Corvalli, G; Di, F; Pezzoni, D; Platto, C; D'Ambrosio, V; Ivaldi, C; Milia, P; DeSalvo, F; Solaro, C; Strazzacappa, M; Bo, M; Panico, A; Cazzadori, M; Confente, S; Bonetto, M; Grasso, M; Troisi, E; Magnani, G; Cecchetti, G; Guerini, V; Bernardini, B; Corsini, C; Boffelli, S; Filippi, A; Delpin, K; Faraci, B; Bertoletti, E; Vannucci, M; Tesi, F; Crippa, P; Malighetti, A; Bettini, D; Maltese, F; Formilan, M; Abruzzese, G; Minaglia, C; Cosimo, D; Azzini, M; Cazzadori, M; Colombo, M; Procino, G; Fascendini, S; Barocco, F; Del, P; D'Amico, F; Grippa, A; Mazzone, A; Riva, E; Dell'Acqua, D; Cottino, M; Vezzadini, G; Avanzi, S; Brambilla, C; Orini, S; Sgrilli, F; Mello, A; Lombardi, L; Muti, E; Dijk, B; Fenu, S; Pes, C; Gareri, P; Castagna, A; Passamonte, M; De, F; Rigo, R; Locusta, L; Caser, L; Rosso, G; Cesarini, S; Cozzi, R; Santini, C; Carbone, P; Cazzaniga, I; Lovati, R; Cantoni, A; Ranzani, P; Barra, D; Pompilio, G; Dimori, S; Cernesi, S; Riccò, C; Piazzolla, F; Capittini, E; Rota, C; Gottardi, F; Merla, L; Barelli, A; Millul, A; De, G; Morrone, G; Bigolari, M; Minaglia, C; Macchi, M; Zambon, F; D'Amico, F; D'Amico, F; Pizzorni, C; DiCasaleto, G; Menculini, G; Marcacci, M; Catanese, G; Sprini, D; DiCasalet, T; Bocci, M; Borga, S; Caironi, P; Cat, C; Cingolani, E; Avalli, L; Greco, G; Citerio, G; Gandini, L; Cornara, G; Lerda, R; Brazzi, L; Simeone, F; Caciorgna, M; Alampi, D; Francesconi, S; Beck, E; Antonini, B; Vettoretto, K; Meggiolaro, M; Garofalo, E; Bruni, A; Notaro, S; Varutti, R; Bassi, F; Mistraletti, G; Marino, A; Rona, R; Rondelli, E; Riva, I; Scapigliati, A; Cortegiani, A; Vitale, F; Pistidda, L; D'Andrea, R; Querci, L; Gnesin, P; Todeschini, M; Lugano, M; Castelli, G; Ortolani, M; Cotoia, A; Maggiore, S; DiTizio, L; Graziani, R; Testa, I; Ferretti, E; Castioni, C; Lombardi, F; Caserta, R; Pasqua, M; Simoncini, S; Baccarini, F; Rispoli, M; Grossi, F; Cancelliere, L; Carnelli, M; Puccini, F; Biancofiore, G; Siniscalchi, A; Laici, C; Mossello, E; Torrini, M; Pasetti, G; Palmese, S; Oggioni, R; Mangani, V; Pini, S; Martelli, M; Rigo, E; Zuccalà, F; Cherri, A; Spina, R; Calamai, I; Petrucci, N; Caicedo, A; Ferri, F; Gritti, P; Brienza, N; Fonnesu, R; Dessena, M; Fullin, G; Saggioro., D
Rivista: JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
Keywords: Hearing impairment, delirium, older, sensory deficits, visual impairment.
Abstract in inglese: Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.
Digital Object Identifier (DOI): 10.1016/j.jamda.2020.09.032
Handle: http://hdl.handle.net/11392/2458378
Appare nelle tipologie:03.1 Articolo su rivista

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