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Symptoms of Delirium Occurring Before and After Episodes of Delirium in Older Long-Term Care Residents

Authors

  • Martin G. Cole MD,

    Corresponding author
    1. St. Mary's Research Center, St. Mary's Hospital Center, Montreal, Quebec, Canada
    2. Department of Psychiatry, McGill University, Montreal, Quebec, Canada
    • Department of Psychiatry, St. Mary's Hospital Center, Montreal, Quebec, Canada
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  • Jane McCusker MD, DrPH,

    1. St. Mary's Research Center, St. Mary's Hospital Center, Montreal, Quebec, Canada
    2. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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  • Philippe Voyer RN, PhD,

    1. Faculty of Nursing Sciences, Laval University, Laval, Quebec, Canada
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  • Johanne Monette MD, MSc,

    1. Division of Geriatric Medicine, Jewish General Hospital, Montreal, Quebec, Canada
    2. Donald Berman Maimonides Geriatric Center, Montreal, Quebec, Canada
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  • Nathalie Champoux MD, MSc,

    1. Department of Family Medicine, Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Quebec, Canada
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  • Antonio Ciampi PhD,

    1. St. Mary's Research Center, St. Mary's Hospital Center, Montreal, Quebec, Canada
    2. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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  • Minh Vu MD,

    1. Division of Geriatric Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
    2. Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
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  • Alina Dyachenko MSc,

    1. St. Mary's Research Center, St. Mary's Hospital Center, Montreal, Quebec, Canada
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  • Eric Belzile MSc

    1. St. Mary's Research Center, St. Mary's Hospital Center, Montreal, Quebec, Canada
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Address correspondence to Dr. Martin G. Cole, Department of Psychiatry, St. Mary's Hospital Center, 3830 Avenue Lacombe, Montreal, Quebec, H3T 1M5, Canada. E-mail: martin.cole@ssss.gouv.qc.ca

Abstract

Objective

To describe Confusion Assessment Method (CAM) core symptoms of delirium occurring before and after incident episodes of delirium in older long-term care (LTC) residents. A secondary objective was to describe the mean number of symptoms before and after episodes by dementia status.

Design

Secondary analysis of data collected for a prospective cohort study of delirium, with repeated weekly assessments for up to 6 months.

Setting

Seven LTC facilities in Montreal and Quebec City, Canada.

Participants

Forty-one older LTC residents who had at least one CAM-defined incident episode of delirium.

Measurements

The Mini-Mental State Examination (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. The frequency, mean number, type, and duration of CAM core symptoms of delirium occurring before and after incident episodes were examined using descriptive statistics, frequency analysis, and survival analysis.

Results

CAM core symptoms of delirium preceded 38 (92.7%) episodes of delirium for many weeks; core symptoms followed 37 (90.2%) episodes for many weeks. Symptoms of inattention and disorganized thinking occurred most commonly. The mean number of symptoms was higher in residents with dementia but not significantly so.

Conclusion

CAM core symptoms of delirium were frequent and protracted before and after most incident episodes of delirium in LTC residents with and without dementia. If replicated, these findings have potentially important implications for clinical practice and research in LTC settings.

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