Delirium in Older Persons: Advances in Diagnosis and Treatment

Oh, Esther S.; Fong, Tamara G.; Hshieh, Tammy T.; Inouye, Sharon K.

doi:10.1001/jama.2017.12067

Cited by 926Intensive Care Unit Cognitive DisordersDementia and Cognitive Impairment ResearchAlcoholism and Thiamine Deficiency

Delirium in Older Persons: Advances in Diagnosis and Treatment

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Oh, Esther S., Fong, Tamara G., Hshieh, Tammy T., Inouye, Sharon K.·2017·JAMA

DOI 10.1001/jama.2017.12067PMC PMC5717753

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Abstract

Importance: Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effects with substantial health care costs. Objective: To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field. Evidence Review: Search of Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011, until March 16, 2017, using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded. Findings: Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment; 4 A's Test; and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies. Conclusions and Relevance: Advances in diagnosis can improve recognition and risk stratification of delirium. Prevention of delirium using nonpharmacologic approaches is documented to be effective, while pharmacologic prevention and treatment of delirium remains controversial.

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DSM-5 recognizes delirium as a cognitive disorder with a disturbance of attention and awareness, often leading to a confusional state or reduced level of consciousness.
“The DSM‐5 recognizes delirium as a cognitive disorder with a disturbance of attention (i.e., reduced ability to direct, focus, sustain and shift attention) and awareness (i.e., reduced orientation to the environment). This often leads to what has been referred to as a confusional state or reduced level of consciousness 180 .”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [180]

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Liu, Y., Ma, L., Gao, M., Guo, W., & Ma, Y. (2015) · Aging Clinical and Experimental Research · doi:10.1007/s40520-015-0492-3 · Cited by 81 · see citing works
Recognizing acute delirium as part of your routine [RADAR]: a validation study
Voyer, P., Champoux, N., Desrosiers, J., Landreville, P., McCusker, J., Monette, J., Savoie, M., Richard, S., & Carmichael, P. (2015) · BMC Nursing · doi:10.1186/s12912-015-0070-1 · Cited by 80 · see citing works
Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia
Cheong, C. Y., Tan, J. A. Q., Foong, Y.-L., Koh, H. M., Chen, D. Z. Y., Tan, J. J. C., Ng, C. J., & Yap, P. L. K. (2016) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000445883 · Cited by 76 · see citing works
Detecting Delirium Superimposed on Dementia: Evaluation of the Diagnostic Performance of the Richmond Agitation and Sedation Scale
Morandi, A., Han, J. H., Meagher, D. J., Vasilevskis, E. E., Cerejeira, J., Hasemann, W., MacLullich, A. M. J., Annoni, G., Trabucchi, M., & Bellelli, G. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.05.010 · Cited by 73 · see citing works
Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial
FUKATA, S., Kawabata, Y., Fujishiro, K., Katagawa, Y., Kuroiwa, K., Akiyama, H., Terabe, Y., Ando, M., Kawamura, T., & Hattori, H. (2014) · Surgery Today · doi:10.1007/s00595-014-0859-7 · Cited by 60 · see citing works
Perioperative plasma melatonin concentration in postoperative critically ill patients: Its association with delirium
Yoshitaka, S., Egi, M., Morimatsu, H., Kanazawa, T., Toda, Y., & Morita, K. (2013) · Journal of Critical Care · doi:10.1016/j.jcrc.2012.11.004 · Cited by 59 · see citing works
Intraoperative Tight Glucose Control Using Hyperinsulinemic Normoglycemia Increases Delirium after Cardiac Surgery
Saager, L., Duncan, A. E., Yared, J., Hesler, B. D., You, J., Deogaonkar, A., Sessler, D. I., & Kurz, A. M. (2015) · Anesthesiology · doi:10.1097/aln.0000000000000669 · Cited by 58 · see citing works
Delirium Outcomes in a Randomized Trial of Blood Transfusion Thresholds in Hospitalized Older Adults with Hip Fracture
Gruber‐Baldini, A. L., Marcantonio, E. R., Orwig, D., Magaziner, J. S., Terrin, M. L., Barr, E. A., Brown, J., Paris, B. E. C., Zagorin, A., Roffey, D. M., et al. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12396 · Cited by 56 · see citing works
Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium
Vochteloo, A. J. H., Moerman, S., van der Burg, B. L. S. B., de Boo, M., de Vries, M. R., Niesten, D. D., Tuinebreijer, W. E., Nelissen, R. G. H. H., & Pilot, P. (2011) · BMC Geriatrics · doi:10.1186/1471-2318-11-39 · Cited by 55 · see citing works
Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: a pragmatic, randomised clinical trial
Wildes, T. S., Winter, A. C., Maybrier, H. R., Mickle, A. M., Lenze, E. J., Stark, S. L., Lin, N., Inouye, S. K., Schmitt, E. M., McKinnon, S., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011505 · Cited by 55 · see citing works
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Delirium Diagnosis Methodology Used in Research: A Survey-Based Study
Neufeld, K. J., Nelliot, A., Inouye, S. K., Ely, E. W., Bienvenu, O. J., Lee, H. B., & Needham, D. M. (2014) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.03.003 · Cited by 53 · see citing works
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Quantifying the Severity of a Delirium Episode Throughout Hospitalization: the Combined Importance of Intensity and Duration
Vasunilashorn, S. M., Marcantonio, E. R., Gou, Y., Pisani, M. A., Travison, T. G., Schmitt, E. M., Jones, R. N., & Inouye, S. K. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3671-9 · Cited by 48 · see citing works
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Feasibility and safety of xenon compared with sevoflurane anaesthesia in coronary surgical patients: a randomized controlled pilot study
Stoppe, C., Fahlenkamp, A. V., Rex, S., Veeck, N. C., Gozdowsky, S. C., Schälte, G., Autschbach, R., Rossaint, R., & Coburn, M. (2013) · British Journal of Anaesthesia · doi:10.1093/bja/aet072 · Cited by 45 · see citing works
Delirium and Cerebrospinal Fluid S100B in Hip Fracture Patients: A Preliminary Study
Hall, R. J., Ferguson, K. J., Andrews, M., Green, A. J. E., White, T. O., Armstrong, I. R., & MacLullich, A. M. J. (2013) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2012.12.024 · Cited by 44 · see citing works
Development of a smartphone application for the objective detection of attentional deficits in delirium
Tieges, Z., Stíobhairt, A., Scott, K., Suchorab, K., Weir, A., Parks, S., Shenkin, S. D., & MacLullich, A. M. J. (2015) · International Psychogeriatrics · doi:10.1017/s1041610215000186 · Cited by 43 · see citing works
Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants
Boockvar, K. S., Teresi, J. A., & Inouye, S. K. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14091 · Cited by 43 · see citing works
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Differential Associations Between Delirium and Mortality According to Delirium Subtype and Age
Kim, S., Kim, S., Kim, J., Shin, I., Bae, K., Shim, H., Bae, W., Cho, S., Chung, I., & Yoon, J. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000239 · Cited by 42 · see citing works
Does Apolipoprotein E Genotype Increase Risk of Postoperative Delirium?
Vasunilashorn, S. M., Ngo, L. H., Kosar, C. M., Fong, T. G., Jones, R. N., Inouye, S. K., & Marcantonio, E. R. (2015) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.12.192 · Cited by 41 · see citing works
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Validation of the Sour Seven Questionnaire for screening delirium in hospitalized seniors by informal caregivers and untrained nurses
Shulman, R. W., Kalra, S., & Jiang, J. (2016) · BMC Geriatrics · doi:10.1186/s12877-016-0217-2 · Cited by 41 · see citing works
Cerebrospinal fluid levels of neopterin are elevated in delirium after hip fracture
Hall, R. J., Watne, L. O., Idland, A., Raeder, J. C., Frihagen, F., MacLullich, A. M. J., Staff, A. C., Wyller, T. B., & Fekkes, D. (2016) · Journal of Neuroinflammation · doi:10.1186/s12974-016-0636-1 · Cited by 41 · see citing works
Effect of cognitively stimulating activities on symptom management of delirium superimposed on dementia: A randomized controlled trial
Kolanowski, A., Fick, D., Litaker, M., Mulhall, P., Clare, L., Hill, N., Mogle, J., Boustani, M., Gill, D., & Yevchak‐Sillner, A. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14511 · Cited by 40 · see citing works
Intracranial cause of delirium: computed tomography yield and predictive factors
Lai, M. M. Y., & Niam, D. M. W. T. (2010) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2010.02400.x · Cited by 40 · see citing works
Quantitative proteomics of delirium cerebrospinal fluid
Poljak, A., Hill, M. A., Hall, R. J., MacLullich, A. M. J., Raftery, M. J., Tai, J. Y. Y., Yan, S., & Caplan, G. A. (2014) · Translational Psychiatry · doi:10.1038/tp.2014.114 · Cited by 40 · see citing works
Prevalence and documentation of impaired mental status in elderly emergency department patients
Hustey, F. M., Meldon, S. W., & Palmer, R. (2000) · PubMed · Cited by 39 · see citing works
Morphine is a Reasonable Alternative to Haloperidol in the Treatment of Postoperative Hyperactive-Type Delirium After Cardiac Surgery
Atalan, N., Sevim, M. E., Akgün, S., Fazlıoğulları, O., & Başaran, C. (2013) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2013.01.017 · Cited by 38 · see citing works
Bright light therapy as an adjunctive treatment with risperidone in patients with delirium: a randomized, open, parallel group study
Yang, J.-W., Choi, W., Ko, Y., Joe, S.-H., Han, C., & Kim, Y. (2012) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2012.05.003 · Cited by 37 · see citing works
Anticholinergic Activity in Cerebrospinal Fluid and Serum in Individuals with Hip Fracture with and without Delirium
Watne, L. O., Hall, R. J., Molden, E., Raeder, J. C., Frihagen, F., MacLullich, A. M. J., Juliebø, V., Nyman, A., Meagher, D. J., & Wyller, T. B. (2014) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12612 · Cited by 36 · see citing works
Retrospective Analysis: Are Fever and Altered Mental Status Indications for Lumbar Puncture in a Hospitalized Patient Who Has Not Undergone Neurosurgery?
Metersky, M. L., Williams, A., & Rafanan, A. L. (1997) · Clinical Infectious Diseases · doi:10.1086/514531 · Cited by 36 · see citing works
The effect of ondansetron on postoperative delirium and cognitive function in aged orthopedic patients.
Papadopoulos, G. A., Pouangare, M., Papathanakos, G., Arnaoutoglou, E. M., Petrou, A., & Tzimas, P. G. (2014) · PubMed · Cited by 30 · see citing works
Longitudinal assessment of serum anticholinergic activity in delirium of the elderly
Munster, B. C. V., Thomas, C., Kreisel, S. H., Brouwer, J. P., Nanninga, S., Kopitz, J., & de Rooij, S. E. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.06.015 · Cited by 30 · see citing works
Screening in delirium: A pilot study of two screening tools, the S imple Q uery for E asy E valuation of C onsciousness and S imple Q uestion in D elirium
Lin, H., Eeles, E. M., Pandy, S., Pinsker, D. M., Brasch, C., & Yerkovich, S. T. (2015) · Australian Journal on Ageing · doi:10.1111/ajag.12216 · Cited by 29 · see citing works
Treatment of delirium with risperidone in cancer patients
Kishi, Y., Kato, M., Okuyama, T., & THURBER, S. D. (2012) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2012.02346.x · Cited by 28 · see citing works
Clinical risk factors for non-convulsive status epilepticus during emergent electroencephalogram
Tu, T. M., Loh, N. K., & Tan, N. C. (2013) · Seizure · doi:10.1016/j.seizure.2013.05.019 · Cited by 28 · see citing works
Interventions for preventing delirium in older people in institutional long-term care
González-Gil, M. T. (2015) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2015.12.009 · Cited by 24 · see citing works
The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture
Akunne, A. F., Davis, S., Westby, M. J., & Young, J. B. (2013) · European Journal of Orthopaedic Surgery & Traumatology · doi:10.1007/s00590-013-1170-9 · Cited by 23 · see citing works
Ontwikkeling en validering van de Informant Assessment of Geriatric Delirium Scale (I-AGeD). Herkenning van delier bij geriatrische patiënten
Rhodius‐Meester, H. F. M., van Campen, J. P. C. M., Fung, W., Meagher, D. J., Munster, B. C. V., & de Jonghe, J. F. M. (2013) · Tijdschrift voor Gerontologie en Geriatrie · doi:10.1007/s12439-013-0028-2 · Cited by 22 · see citing works
Screening for delirium within the interrai acute care assessment system
Salih, S. A., Paul, S. K., Klein, K., Lakhan, P., & Gray, L. (2012) · The journal of nutrition health & aging · doi:10.1007/s12603-012-0074-4 · Cited by 22 · see citing works
Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium: a prospective cohort study
Pedersen, S. S., Kirkegaard, T., Jørgensen, M. B., & Jørgensen, V. L. (2013) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1093/icvts/ivt501 · Cited by 21 · see citing works
Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study
Oh, C.-S., Rhee, K.-Y., Yoon, T. G., Woo, N.-S., Hong, S., & Kim, S. (2016) · BioMed Research International · doi:10.1155/2016/1054597 · Cited by 21 · see citing works
Development and validation of the Informant Assessment of Geriatric Delirium Scale (I-AGeD). Recognition of delirium in geriatric patients
Rhodius‐Meester, H. F. M., van Campen, J. P. C. M., Fung, W., Meagher, D. J., Munster, B. C. V., & de Jonghe, J. F. M. (2013) · European Geriatric Medicine · doi:10.1016/j.eurger.2012.11.006 · Cited by 20 · see citing works
Perioperative gabapentin and delirium following total knee arthroplasty: a post-hoc analysis of a double-blind randomized placebo-controlled trial
Dighe, K., Clarke, H. A., McCartney, C. J. L., & Wong, C. L. (2014) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-014-0235-5 · Cited by 19 · see citing works
Glucocorticoid receptor haplotype is associated with a decreased risk of delirium in the elderly
Manenschijn, L., van Rossum, E. F. C., Jetten, A. M., de Rooij, S. E., & Munster, B. C. V. (2011) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.31165 · Cited by 18 · see citing works
The Tryptophan Depletion Theory in Delirium: Not Confirmed in Elderly Hip Fracture Patients
de Jonghe, A., Munster, B. C. V., Fekkes, D., van Oosten, H. E., & de Rooij, S. E. (2012) · Psychosomatics · doi:10.1016/j.psym.2011.09.009 · Cited by 18 · see citing works
Effects of oral premedication on cognitive status of elderly patients undergoing cardiac catheterization.
Ashraf, J. M., Schweiger, M. J., Vallurupalli, N. G., Bellantonio, S., & Cook, J. R. (2015) · Europe PMC (PubMed Central) · doi:10.11909/j.issn.1671-5411.2015.03.017 · Cited by 9 · see citing works
Comparison of a specialist Medical and Mental Health Unit with standard care for older people with delirium and dementia admitted to a general hospital: A randomised controlled trial (NIHR TEAM trial)
Goldberg, S. E., Bradshaw, L. E., Whittamore, K. H., Gladman, J. R. F., & Harwood, R. (2013) · European Geriatric Medicine · doi:10.1016/j.eurger.2013.07.579 · Cited by 1 · see citing works

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The Alzheimer’s Disease Clinical Spectrum
Atri, A. (2019) · Medical Clinics of North America · doi:10.1016/j.mcna.2018.10.009 · Cited by 623 · see citing works
“The deliriumdementia link has been reviewed in the literature.(59,60) Tier 1 to 2 CBS or dementia assessment laboratory tests or studies (see Table 4) can help identify common conditions that exacerbate symptoms, including dehydration, electrolyte and metabolic derangements, anemia, cardiac or cerebral ischemia, hypox…”
Perspectives on ethnic and racial disparities in Alzheimer's disease and related dementias: update and areas of immediate need
Babulal, G. M., Quiroz, Y. T., Albensi, B. C., Arenaza‐Urquijo, E., Astell, A. J., Babiloni, C., Bahar‐Fuchs, A., Bell, J., Bowman, G. L., Brickman, A. M., et al. (2019) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2018.09.009 · Cited by 528 · see citing works
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Hospital elder life program: systematic review and meta-analysis of effectiveness
Hshieh, T. T., Yang, T., Gartaganis, S. L., Yue, J., & Inouye, S. K. (2018) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.06.007 · Cited by 466 · see citing works
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Mental health care for older adults: recent advances and new directions in clinical practice and research
Reynolds, C. F., Jeste, D. V., Sachdev, P. S., & Blazer, D. G. (2022) · World Psychiatry · doi:10.1002/wps.20996 · Cited by 465 · see citing works
The inter-relationship between delirium and dementia: the importance of delirium prevention
Fong, T. G., & Inouye, S. K. (2022) · Nature Reviews Neurology · doi:10.1038/s41582-022-00698-7 · Cited by 404 · see citing works
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Anaesthetic depth and delirium after major surgery: a randomised clinical trial
Evered, L. A., Chan, M. T. V., Han, R., Chu, M. H. M., Cheng, B. P., Scott, D. A., Pryor, K. O., Sessler, D. I., Veselis, R. A., FRAMPTON, C. M. A., et al. (2021) · British Journal of Anaesthesia · doi:10.1016/j.bja.2021.07.021 · Cited by 394 · see citing works
Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association
Damluji, A. A., Forman, D. E., Wang, T. Y., Chikwe, J., Kunadian, V., Rich, M. W., Young, B. A., Page, R. L., II, DeVon, H. A., & Alexander, K. P. (2022) · Circulation · doi:10.1161/cir.0000000000001112 · Cited by 381 · see citing works
Current and future treatments in Alzheimer’s disease
Atri, A. (2019) · Seminars in Neurology · doi:10.1055/s-0039-1678581 · Cited by 309 · see citing works
Delirium in Older Patients With COVID-19 Presenting to the Emergency Department
Kennedy, M., Helfand, B., Gou, R. Y., Gartaganis, S. L., Webb, M. A., Moccia, J. M., Bruursema, S., Dokic, B., McCulloch, B., Ring, H., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.29540 · Cited by 290 · see citing works
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Domain Management Approach to Heart Failure in the Geriatric Patient
Gorodeski, E. Z., Goyal, P., Hummel, S. L., Krishnaswami, A., Goodlin, S. J., Hart, L. L., Forman, D. E., WENGER, N. K., Kirkpatrick, J. N., & Alexander, K. P. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.02.059 · Cited by 264 · see citing works
Neurocognitive Function after Cardiac Surgery
Berger, M., Terrando, N., Smith, S. K., Browndyke, J. N., Newman, M. F., & Mathew, J. P. (2018) · Anesthesiology · doi:10.1097/aln.0000000000002194 · Cited by 264 · see citing works
One-Year Medicare Costs Associated With Delirium in Older Patients Undergoing Major Elective Surgery
Gou, R. Y., Hshieh, T. T., Marcantonio, E. R., Cooper, Z. R., Jones, R. N., Travison, T. G., Fong, T. G., Abdeen, A. R., Lange, J. K., Earp, B. E., et al. (2021) · JAMA Surgery · doi:10.1001/jamasurg.2020.7260 · Cited by 253 · see citing works
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Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review
Nikooie, R., Neufeld, K. J., Oh, E. S., Wilson, L. M., Zhang, A., Robinson, K. A., & Needham, D. M. (2019) · Annals of Internal Medicine · doi:10.7326/m19-1860 · Cited by 246 · see citing works
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Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis
Tieges, Z., MacLullich, A. M. J., Anand, A., Brookes, C., Cassarino, M., O’connor, M., Ryan, D., Saller, T., Arora, R. C., Chang, Y., et al. (2020) · Age and Ageing · doi:10.1093/ageing/afaa224 · Cited by 236 · see citing works
State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018
Mahanna, E., Schenning, K. J., Eriksson, L. I., Browndyke, J. N., Wright, C. B., Evered, L. A., Scott, D. A., Wang, N. Y., Brown, C. H., Oh, E. S., et al. (2019) · British Journal of Anaesthesia · doi:10.1016/j.bja.2019.07.004 · Cited by 231 · see citing works
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Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum
Mate, K. S., Fulmer, T. T., Pelton, L. J., Berman, A. J., Bonner, A., Huang, Y., & Zhang, J. (2021) · Journal of Aging and Health · doi:10.1177/0898264321991658 · Cited by 226 · see citing works
Management of proximal femur fractures in the elderly: current concepts and treatment options
Fischer, H., Maleitzke, T., Eder, C., Ahmad, S. S., Stöckle, U., & Braun, K. F. (2021) · European journal of medical research · doi:10.1186/s40001-021-00556-0 · Cited by 206 · see citing works
Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method
Shenkin, S. D., Fox, C., Godfrey, M., Siddiqi, N., Goodacre, S. W., Young, J. B., Anand, A., Gray, A. J., Hanley, J., MacRaild, A., et al. (2019) · BMC Medicine · doi:10.1186/s12916-019-1367-9 · Cited by 203 · see citing works
Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment
Kong, H., Xu, L., & Wang, D. (2022) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.13873 · Cited by 206 · see citing works
Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults
Wang, Y., Yue, J., Xie, D., Carter, P. A., Li, Q., Gartaganis, S. L., Chen, J., & Inouye, S. K. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.4446 · Cited by 192 · see citing works
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The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management
(2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000668 · Cited by 194 · see citing works
Proximal Femoral Fractures in the Elderly: A Few Things to Know, and Some to Forget
Maffulli, N., & Aicale, R. (2022) · Medicina · doi:10.3390/medicina58101314 · Cited by 184 · see citing works
The Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis
Gracie, T. J., Caufield-Noll, C. P., Wang, N., & Sieber, F. E. (2021) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000005609 · Cited by 165 · see citing works
Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions
Carrarini, C., Russo, M., Dono, F., Barbone, F., Rispoli, M. G., Ferri, L., Pietro, M. D., Digiovanni, A., Ajdinaj, P., Speranza, R., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.644317 · Cited by 159 · see citing works
Infections in the Elderly Critically-Ill Patients
Eşme, M., Topeli̇, A., Doğu, B. B., & Akova, M. (2019) · Frontiers in Medicine · doi:10.3389/fmed.2019.00118 · Cited by 157 · see citing works
Delirium
Thom, R. P., Levy‐Carrick, N. C., Bui, M. P., & Silbersweig, D. (2019) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.18070893 · Cited by 141 · see citing works
Acute peri‐operative neurocognitive disorders: a narrative review
Evered, L. A., Atkins, K. J., SILBERT, B. S., & Scott, D. A. (2022) · Anaesthesia · doi:10.1111/anae.15613 · Cited by 128 · see citing works
Perioperative dexmedetomidine reduces delirium after cardiac surgery: A meta-analysis of randomized controlled trials
Wu, M., Liang, Y., Dai, Z., & Wang, S. (2018) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2018.06.045 · Cited by 124 · see citing works
Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis
Campbell, A., Axon, D. R., Martin, J. R., Slack, M. K., Mollon, L. E., & Lee, J. K. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1297-6 · Cited by 119 · see citing works
Postoperative delirium in geriatric patients with hip fractures
Chen, Y., Liang, S., Wu, H., Deng, S., Wang, F., Lunzhu, C., & Li, J. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.1068278 · Cited by 113 · see citing works
Antipsychotics for Preventing Delirium in Hospitalized Adults: A Systematic Review
Oh, E. S., Needham, D. M., Nikooie, R., Wilson, L. M., Zhang, A., Robinson, K. A., & Neufeld, K. J. (2019) · Annals of Internal Medicine · doi:10.7326/m19-1859 · Cited by 108 · see citing works
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Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement
Carpenter, C. R., Hammouda, N., Linton, E. A., Doering, M. M., Ohuabunwa, U. K., Ko, K. J., Hung, W. W., Shah, M. N., Lindquist, L. A., Biese, K., et al. (2020) · Academic Emergency Medicine · doi:10.1111/acem.14166 · Cited by 104 · see citing works
Delirium in hospitalized older adults
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Authors: Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K.
Affiliations: Johns Hopkins University (US)
Beth Israel Deaconess Medical Center (US)
Brigham and Women's Hospital (US)
ORCID: Oh, Esther S.
Fong, Tamara G.
Hshieh, Tammy T.
Inouye, Sharon K.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2017-09-26
Volume: 318
Issue: 12
Pages: 1161
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2017.12067
PMC: PMC5717753
OpenAlex: W2759229677
Cited by: 926
References: 116
Citations by year: 2026: 88 · 2025: 113 · 2024: 90 · 2023: 103 · 2022: 163 · 2021: 139 · 2020: 90 · 2019: 82 · 2018: 53 · 2017: 1 · 2016: 1 · 2012: 1
FWCI: 58.11
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR001102)
National Institute on Aging (P01AG031720, K07AG041835, P50AG005146, R24AG054259, R01AG044518, K23AG043504)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
Keywords: delirium, older adults, delirium diagnosis, delirium screening tools, Confusion Assessment Method, delirium severity assessment, delirium prevention, non-pharmacological treatment, immobility, antipsychotic drugs, sedating medications, delirium management, risk stratification
MeSH terms: Emergence Delirium, Aged, Delirium, Electroencephalography, Humans, Severity of Illness Index, Antipsychotic Agents, Biomarkers, Geriatric Assessment, Practice Guidelines as Topic

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