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Delirium in the Nursing Home Patients Seen in the Emergency Department

Authors

  • Jin H. Han MD, MSc,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • Alessandro Morandi MD,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • E. Wesley Ely MD, MPH,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • Clay Callison MD,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • Chuan Zhou PhD,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • Alan B. Storrow MD,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • Robert S. Dittus MD, MPH,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • Ralf Habermann MD,

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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  • John Schnelle PhD

    1. From the *Department of Emergency MedicineCenter for Health Services Research§Divisions of Allergy, Pulmonary, and Critical Care††General Internal Medicine and Public Health, #Department of Internal Medicine**Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TennesseeDepartment of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, ItalyVeterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Veterans Affairs Service, Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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Address correspondence to Jin H. Han, Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232-4700. E-mail: Jin.h.han@vanderbilt.edu

Abstract

OBJECTIVES: To determine whether nursing home patients are more likely than non-nursing home patients to present to the emergency department (ED) with delirium and to explore how variations in their delirium risk factor profiles contribute to this relationship.

DESIGN: Prospective cross-sectional study.

SETTING: Tertiary care academic ED.

PARTICIPANTS: Three hundred forty-one English-speaking patients aged 65 and older.

MEASUREMENTS: Delirium status was determined using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Multivariable logistic regression was used to determine whether nursing home residence was independently associated with delirium. Adjusted odds ratios (ORs) with their 95% confidence intervals (95% CIs) were reported.

RESULTS: Of the 341 patients enrolled, 58 (17.0%) resided in a nursing home and 38 (11.1%) were considered to have delirium in the ED. Of the 58, (22 (37.9%) nursing home patients and 16 of 283 (5.7%) non-nursing home patients had delirium; unadjusted OR=10.2, 95% CI=4.9–21.2). After adjusting for dementia, a Katz activity of daily living score less than or equal to 4, hearing impairment, and the presence of systemic inflammatory response syndrome, nursing home residence was independently associated with delirium in the ED (adjusted OR=4.2, 95% CI=1.8–9.7).

CONCLUSION: In the ED setting, nursing home patients were more likely to present with delirium, and this relationship persisted after adjusting for delirium risk factors.

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