Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 63, Issue 5, Pages 970-976Publisher
WILEY
DOI: 10.1111/jgs.13334
Keywords
delirium; psychomotor subtypes; hip fracture; Memorial Delirium Assessment Scale; Confusion Assessment Method
Categories
Funding
- National Heart, Lung, and Blood Institute [R01 HL085706, U01 HL073958, U01 HL074815]
- National Institute on Aging [T32 AG00262]
- Claude D. Pepper Older Americans Independence Center, National Institute on Aging [P30 AG028747]
- Agency for Healthcare Research and Quality [R36HS021068-01]
- National Institutes of Health [T32AG000262-14]
- Mid-Career Investigator Award in Patient-Oriented Research from the National Institute on Aging [K24 AG035075]
- Ammonett LLC
- Amgen
- Eli Lilly
- Glaxo SmithKline
- Merck
- Novartis
- Sanofi Aventis
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ObjectivesTo determine the stability of psychomotor subtypes of delirium over time and identify characteristics associated with delirium psychomotor subtypes in individuals undergoing surgical repair of hip fracture. DesignProspective cohort study. SettingThe Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair Cognitive Ancillary Study was conducted at 13 participating sites from 2008 to 2009. ParticipantsIndividuals who had undergone surgical repair of hip fracture (N=139). MeasurementsDelirium was assessed up to four times postoperatively using the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale. Psychomotor subtypes of delirium were categorized as hypoactive, hyperactive, mixed, and normal psychomotor activity. ResultsIncidence of postoperative delirium was 41% (n=57). Of 90 CAM-positive (CAM+) observations, 56% were hypoactive, 10% were hyperactive, 21% were mixed, and 14% had normal psychomotor symptoms. Of 26 participants with more than one CAM+ assessment, 50% maintained subtype stability over time. Participants with hypoactive or normal psychomotor symptoms (n=31) were less likely to have chart documentation of delirium than participants with any hyperactive symptoms (n=19) (22% vs 58%, P=.009). ConclusionPsychomotor subtypes of delirium often fluctuate from assessment to assessment, rather than representing fixed categories of delirium. Hypoactive delirium is the most common presentation of delirium but is the least likely to be documented by healthcare providers.
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