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ABSTRACTS GERICON-2021
Year : 2021  |  Volume : 17  |  Issue : 4  |  Page : 126

RESEARCH WING IAG BEST THESIS AWARD 2021


Date of Web Publication21-Dec-2021

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-3405.332861

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How to cite this article:
. RESEARCH WING IAG BEST THESIS AWARD 2021. J Indian Acad Geriatr 2021;17:126

How to cite this URL:
. RESEARCH WING IAG BEST THESIS AWARD 2021. J Indian Acad Geriatr [serial online] 2021 [cited 2023 Feb 8];17:126. Available from: http://www.jiag.com/text.asp?2021/17/4/126/332861


  Incidence and Prevalence of Delirium and its Sociodemographic, Clinical and Biochemical Correlates in Geriatric Population Top


Yamini Ajmera, Avinash Chakrawarty

Department of Geriatrics, AIIMS, New Delhi

Background: Delirium is a complex, reversible neuropsychiatric disorder, typically characterised by alteration in level of consciousness and cognitive deficits with additional deficits in non-cognitive domains. It is a highly frequent condition in geriatric age group in acute care settings with multiple contributing factors and is associated with significant morbidity and mortality.

Objectives: This study is aimed at evaluating the incidence, prevalence and outcome of delirium and its association with various sociodemographic, clinical and biochemical correlates in patients aged 60 years and above admitted in the geriatric ward of a tertiary care hospital.

Methods: A prospective study design with consecutive patients selection was used. Participants were assessed at baseline and daily thereafter till the time of discharge or death using CAM or CAM-ICU (in case of HDU admission) with subsequent division into Delirium group and Non-Delirium group. The functional status two weeks before admission and on admission was assessed using Katz-ADL scale. For evaluation of baseline cognitive status and psychopathological symptoms, IQCODE-SF and BPRS scale were used respectively. In patients diagnosed with delirium, motoric subtyping was done using RAAS score and phenomenology was assessed using DRS-R98 tool. The novel biomarkers assessed at baseline included serum leptin, adiponectin and neopterin.

Results: Out of 200 recruited patients, 30 (15%) were diagnosed with delirium within 24 hours of admission and 10 (5% - incidence rate) developed it later during their hospital stay yielding a prevalence rate of 20%. Hypoactive delirium (77.5%) was the most frequent motoric subtype. The most common aetiologies identified were sepsis (50%) followed by intracranial pathologies and electrolyte disturbances. As per phenomenology of delirium, almost all patients were found to have disturbances in sleep wake cycle, orientation, attention, long term and short term memory. The univariate logistic regression analysis identified age, emergency mode of admission, HDU admission, greater cognitive and functional decline (as evidenced by higher IQCODE-SF and lower Katz-ADL scores), more general psychopathological symptoms (as evidenced by higher BPRS total scores), high NLR values and sodium levels and low albumin and leptin levels as independent risk factors of delirium. It also identified delirium to be an independent predictor of mortality. Multivariate logistic regression analysis resulted in HDU admission (OR=9.83, 95% CI 2.96-32.5, p=0.001), more general psychopathological symptoms (indicated by higher BPRS total scores) (OR=1.16, 95% CI 1.07-1.26, p=0.001), greater functional impairment (indicated by lower Katz-ADL scores on admission) (OR=0.53, 95% CI 0.34-0.82, p=0.004) and low leptin levels (OR= 0.93, 95% CI 0.88-0.98, p=0.02) as independent predictors of delirium.

Conclusion: Delirium is a commonly encountered condition with multifactorial causation and high mortality in geriatric wards. Leptin might serve as a potential biomarker owing to its probable role in the pathophysiological processes of delirium. Assessment of variables like cognitive and functional status as well as psychopathological symptomatology should be done routinely at the time of admission to establish those at risk and advance the management plan and prognosis.




 

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