Detection of delirium and its symptoms by nurses working in a long term care facility

Abstract

Objective: To investigate the ability of nurses to recognize delirium and its symptoms and to investigate the factors associated with undetected delirium.

Design: A prospective, observational study with repeated measurements over a 6-month period.

Setting: Seven long term care settings in Montreal and Quebec City, Canada.

Participants: Residents aged 65 and older, with or without dementia, admitted to long term care (not respite care) and able to communicate in English or French.

Measurements: Delirium and its symptoms were assessed using the Confusion Assessment Method. Ratings of delirium by nurses based on their observations during routine care were compared with delirium ratings by trained research assistants based on a one-time formal structured evaluation (Confusion Assessment Method and Mini Mental State Examination). This procedure was repeated for 10 delirium symptoms. Sensitivity, specificity, and positive and negative predictive values were calculated. The method of generalized estimating equations was used to identify factors associated with undetected delirium.

Results: Research assistants identified delirium in 43 (21.3%) of the 202 residents. Nurses identified delirium in 51% of the cases identified by the research assistants. However, for cases without delirium according to the research assistants, nurses identified 90% of them correctly. Detection rates for delirium symptoms ranged from 25% to 66.7%. Undetected delirium was associated with lower number of depressive symptoms manifested by the resident.

Conclusion: Detection of delirium is a major issue for nurses. Strategies to improve nurse recognition of delirium could well reduce adverse outcomes for this vulnerable population.