P2‐040: Delta Project: Delirium in Hospitalized Elderly

Delirium is a common problem in acute care hospitals. In the medical population, its prevalence is estimated to be 15-25%, while its incidence is 5-10%. In the surgical population, the incidence is 10-15% in general surgery, 30% in cardiothoracic surgery and up to 50% in orthopedics. Diagnosis of delirium is associated with medical and administrative consequences. However, delirium remains under-diagnosed and under-reported. The objectives of this study were: 1) to determine the incidence and prevalence of delirium in a medical and surgical population at the CHUM; 2) to find what keywords in the nursing and medical charts and risk factors were associated with delirium; 3) to evaluate the management and consequences of delirium; 4) to examine under-diagnosis and under-reporting of delirium. Retrospective study of 368 charts of elderly patients (> 75yo) from medical and surgical departments of the CHUM. Patients were on average 81,4 yo and most lived in the community. Delirium was found in 31 % and 28 % of medical and surgical patients and was present upon arrival in 4.5% and 2% respectively. A diagnosis of dementia was the main risk factor for delirium in the medical population. Length of stay (21 vs 13 days; 19 vs 10 days) and mortality (30% vs 9%; 20% vs 3%) were significantly increased in patients with delirium in medical and surgical populations. Fewer patients with delirium were discharged home. Delirium was missed in 40% and not reported in the chart summary in 74 % of patients. Key words such as “confusion”, “incoherence” and “disorientation” were associated with a diagnosis of delirium. The incidence of delirium in these populations was high. Delirium has a clear impact on length of stay and mortality. Although key symptoms are recognized by clinicians and other health care workers, delirium remains under-diagnosed.