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Delirium in hospitalized older patients with cancer.

Bond SM, Neelon VJ, Belyea MJ

School of Nursing, University of North Carolina at Chapel Hill, USA. bond@email.unc.edu

PURPOSE/OBJECTIVES: To examine key aspects of delirium in a sample of hospitalized older patients with cancer. DESIGN: Secondary analysis of data from studies on acute confusion in hospitalized older adults. SETTING: Tertiary teaching hospital in the southeastern United States. SAMPLE: 76 hospitalized older patients with cancer (mean age = 74.4 years) evenly divided by gender and ethnicity and with multiple cancer diagnoses. METHODS: Data were collected during three studies of acute confusion in hospitalized older patients. Delirium was measured with the NEECHAM Confusion Scale on admission, daily during hospitalization, and at discharge. Patient characteristics and clinical risk markers were determined at admission. MAIN RESEARCH VARIABLES: Prevalent and incident delirium, etiologic risk patterns, and patient characteristics. FINDINGS: Delirium was noted in 43 (57%) patients; 29 (38%) were delirious on admission. Fourteen of 47 (30%) who were not delirious at admission became delirious during hospitalization. Delirium was present in 30 patients (39%) at discharge. Most delirious patients had evidence of multiple (mean = 2.3) etiologic patterns for delirium. CONCLUSIONS: Delirium was common in this sample of hospitalized older patients with cancer. Patients with delirium were more severely ill, were more functionally impaired, and exhibited more etiologic patterns than nondelirious patients. IMPLICATIONS FOR NURSING: Nurses caring for older patients with cancer should perform systematic and ongoing assessments of cognitive behavioral performance to detect delirium early. The prevention and management of delirium hinge on the identification and treatment of the multiple risk factors and etiologic mechanisms that underlie delirium. The large number of patients discharged while still delirious has significant implications for posthospital care and recovery.

Published 6 December 2006 in Oncol Nurs Forum, 33(6): 1075-83.
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