A world-wide study on delirium assessments and presence of protocols
Peter Nydahl, Keibun Liu, Giuseppe Bellelli, Julie Benbenishty, Mark van den Boogaard, Gideon A. Caplan, Chi Ryang Chung, Muhammed Elhadi, Mohan Gurjar, Gabi Heras-La Calle, Magdalena Hoffmann, Marie‐Madlen Jeitziner, Karla D. Krewulak, Tanya Mailhot, Alessandro Morandi, Ricardo Kenji Nawa, Esther S. Oh, Marie Oxenbøll Collet, Maria Carolina Paulino, Heidi Lindroth, Rebecca von Haken, the WDAD Study Group, Ahmed Gaber Ahmed Abdalgany, Sarah Magdy Abdelmohsen, Amjad Aburaas, Christina Aggar, Bashir Abobaker Albakosh, Hamza Ismail Ahmad Alhamdan, Akram Waled Rajab M Aljbali, Fareeda Al-Kandari, Akram Alkaseek, Daniel Anders, Marsali Anderson, Shelly Ashkenazy, Thiago Avelino, Kasia Bail, Ashraf Bakri, Alaa Mohamed Ali Baroum, Bronagh Blackwood, Jennifer Brendt-Müller, Angelika Brobeil, Richard Burke, Tru Byrnes, Stefano Cacciatore, Maria Cahill, Maria Ana Canelas, Ida Carroll, Amy Conley, Maria Costello, Shannon A. Cotton, Mandy Couser, A. Salgado, Elizabeth Cusworth, Vera Cvoro, Jordanna Deosaran, Merel Diebels, Elaine A Docherty, Vera von Dossow, Megan Drennan, Akram Amin Egdeer, Patrick Eichelsheim, Aissha Ali Saleh Elagili, Saifaleslam Jamal Elsahl, Hajer Alsadeg Mohammed Elshaikh, Christina Emme, Matthias Thomas Exl, Azza Fathi, Melanie Feige, Kirsten M. Fiest, Marleta Irene Joy Fong, Mikita Fuchita, Carol Gaffney, Carola Giménez-Esparza Vich, Nicole Feldmann, Rachel Fitzgerald, Neasa Fitzpatrick, Marleta Irene Joy Fong, María Adela Goldberg, Nienke M.S. Golüke, Marinette van der Graaf, Engelina Groenewald, Renate Gross, Camilla Grube Segers, Renate Hadi, Qusai Ahmad Hasan Hamdan, Bahaeddin Ben Hamida, Monalyce Hamza, Breanna Hetland, Jane Hopkins, John Hopkins, Said A. Ibrahim, Guglielmo Imbrìaco, Shigeaki Inoue, Arveen Jeyaseelan, Ali Jawad Kadhim, S. Kohler, Rens Kooken, Anna Korompeli, Lars Krüger, Ayman Salim Abu Khutwah
Abstract
BACKGROUND: Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities. OBJECTIVE: To assess the worldwide use of validated delirium assessment tools and the presence of delirium management protocols. DESIGN: Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023. SETTING: Cross-sectional online survey including hospitals, rehabilitation and long-term facilities. METHODS: Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers. RESULTS: Data from 44 countries, 1664 wards/units and 36 048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol [n = 1094/1664, 66.8%] were more likely to use a validated delirium test than those without a protocol [odds ratio 6.97 (95% confidence interval 5.289-9.185)]. The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions. CONCLUSION: Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium.