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Zusammenfassung Masterarbeit Lili Cao

Medication-Associated Delirium Risk Assessment in Geriatric Inpatients


The occurrence of delirium in geriatric patients is a great challenge due to its high prevalence and severe consequences. The aim of this study was the description of the current situation at geriatric wards in the Johanniter Hospital for later assessment of the efficacy of non-pharmacological interventions on both delirium prevalence and drug treatment.
All geriatric patients were screened between August and December 2016 in the Johanniter Hospital. Baseline characteristics of the patients, including demographic data (age, gender), a geriatric assessment and a delirium risk assessment were documented. The geriatric assessment consisted of the Barthel Index (BI), Mini-Mental-State Examination (MMSE), Clock Drawing Test (CDT) and Geriatric Delirium Scale (GDS). The delirium risk assessment consisted of uncontrolled pain, infection, the Delirium Predictive Score (DPS), potentially inappropriate medication (PIM) and the anticholinergic burden. As primary and secondary endpoint, delirium prevalence and new prescriptions of centrally active delirants in the hospital were assessed and analysed, respectively.
79 patients were included in the study. The average age of the study population was 83 (± 6) years. Female patients were predominant (72%). In terms of the geriatric assessment, mean values of CDT and GDS between delirium and non-delirium patients did not differ from each other. In contrary, mean values of the BI and the MMSE score of delirium patients were significantly lower compared to non-delirium patients (26 vs. 50 and 18 vs. 24; p < 0.05) and the DPS of delirium patients was significantly higher (24 vs. -48; p < 0.05), indicating the critical conditions of delirium patients at baseline.
More delirium patients were exposed to PIM according to the PRISCUS list and an anticholinergic burden determined by the Anticholinergic Cognitive Burden Scale (ACB). With regard to PIM, a two-fold higher percentage of delirium patients took ≥ 1 PRISCUS drugs (38% vs. 18%), which could be reduced to the percentage of non-delirium patients (13% vs. 11%) after the first week in the hospital. In contrary, the percentage of delirium patients with an ACB total score ≥ 3 increased four times (from 13% to 50%) and the median anticholinergic burden per patient five times (from 0.5 to 2.5) after admission. The high anticholinergic burden in delirium patients further points out the relevance of non-pharmacological interventions that are supposed to reduce the need for a drug treatment including PRISCUS and anticholinergic drugs in geriatric patients.
The high medication-associated risks of delirium patients in the hospital were further confirmed by the median new prescription rate (2.4 vs. 1.0 per patient). In terms of neuroleptics, the percentage of newly prescribed neuroleptics in delirium patients was four-fold higher (37% vs. 9%) and the duration of neuroleptics intake two times longer than for non-delirium patients (20 vs. 12 days).
In conclusion, delirium patients were more vulnerable at baseline. Furthermore, the prescription rate and the number of newly prescribed neuroleptics were higher in delirium patients, indicating the need for non-pharmacological interventions.