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Independently, malnutrition and delirium in older hospitalised adults is prevalent. However, there is limited evidence on the association between these two conditions in older hospitalised adults with chronic kidney disease (CKD). To determine the association between malnutrition and delirium in older CKD patients admitted to intensive care units (ICU). This data linkage study utilised administrative data from New South Wales (NSW) hospitals in Australia between 2017 and 2020. Admitted patient data was linked with Cause of Death Unit Record File, and NSW Registry of Deaths (RBD). The study population comprised all CKD patients aged 65 and over admitted to ICUs. Descriptive statistics were used to summarise patient characteristics. Binary logistic tested for association between malnutrition and delirium. The study population included 748 CKD patients with a total 948 admissions in the study period. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) was used to code for all outcomes and comorbidities. The incidence of delirium was 15.5% (n=141) and malnutrition was recorded in 11.3% (n=103) across all admissions. The adjusted odds ratio (OR) of a delirium diagnosis was 2.07 (95% CI: 1.27–3.39) for CKD patients that were malnourished compared to non-malnourished CKD patients. This study showed a significant association between delirium and malnutrition in older CKD patients admitted to ICU. Management of malnutrition could be critical in reducing the risk of delirium in older hospitalized patients with CKD. Additionally, more education and awareness around delirium and its association with malnutrition are needed in clinical practice.

Background We have previously described the development of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen for use in populations with low levels of formal education. The IDEA cognitive screen was developed and field-tested in an elderly, community-based population in rural Tanzania with a relatively high prevalence of cognitive impairment. The aim of this study was to validate the IDEA cognitive screen as an assessment of major cognitive impairment in hospital settings in Nigeria and Tanzania. Methods In Nigeria, 121 consecutive elderly medical clinic outpatients reviewed at the University College Hospital, Ibadan were screened using the IDEA cognitive screen. In Tanzania, 97 consecutive inpatients admitted to Mawenzi Regional Hospital (MRH), Moshi, and 108 consecutive medical clinic outpatients attending the geriatric medicine clinic at MRH were screened. Inter-rater reliability was assessed in Tanzanian outpatients attending St Joseph’s Hospital in Moshi using three raters. A diagnosis of dementia or delirium (DSM-IV criteria) was classified as major cognitive impairment and was provided independently by a physician blinded to the results of the screening assessment. Results The area under the receiver operating characteristic (AUROC) curve in Nigerian outpatients, Tanzanian outpatients and Tanzanian inpatients was 0.990, 0.919 and 0.917 respectively. Inter-rater reliability was good (intra-class correlation coefficient 0.742 to 0.791). In regression models, the cognitive screen did not appear to be educationally biased. Conclusions The IDEA cognitive screen performed well in these populations and should prove useful in screening for dementia and delirium in other areas of sub-Saharan Africa.

Mental health conditions are ubiquitous, and it is critical to seek help for them. For Black people, however, help comes with substantial risk. One manifestation of this risk ended Daniel Prude’s life, but it does not have to end his story.

ObjectiveDelirium is one of the most common acute psychiatric disturbances taking place in patients, particularly elderly, following hip fractures. Using a validated national surgical database, we sought to define the incidence, risk factors and clinical impact associated with the occurrence of delirium following open reduction and internal fixation (ORIF) for hip fracture.MethodsThe 2016 American College of Surgeons—National Surgical Quality Improvement Program (ACS-NSQIP) Hip Fracture Targeted Procedure file—was retrieved and merged with the ACS-NSQIP 2016 file. A total of 7859 patients were finally included in the study.ResultsA total of 2177 (27.7%) patients experienced an episode of delirium following the procedure. Adjusted analysis showed an increasing age ≥ 65 years (p < 0.001), partially dependent functional health status prior to surgery (p = 0.001), bleeding disorder (p = 0.012), preoperative dementia (p < 0.001), preoperative delirium (p < 0.001), being bed-ridden postoperatively (p < 0.001), no weight bearing as tolerated on first postoperative day (p < 0.001), an ASA grade > II (p < 0.001), non-emergency case (p = 0.010) and a prolonged length of stay > 3 days (p < 0.001). In addition, Black or African-American ethnicity had a lower odds of developing postoperative delirium (p = 0.020) as compared to Whites. Moreover, postoperative delirium was significantly associated with non-home discharge disposition (p < 0.001), higher odds of 30-day readmissions (p < 0.001) and 30-day mortality (p < 0.001).ConclusionThis study identifies several risk factors associated with the occurrence of postoperative delirium in patients undergoing ORIF for hip fracture. Surgeons can utilize these data to risk stratify and consequently tailor an appropriate preoperative and postoperative care protocol to prevent the occurrence of delirium.

Accurate pain assessment is essential for the effective pain management of geriatric patients. This study evaluated the concurrent validity of the Pain Assessment in Advanced Dementia–Thai version (PAINAD-Th), against self-reported pain in postoperative geriatric patients. Additionally, we examined the utility of the PAINAD-Th for assessing pain response to analgesic intervention. This descriptive correlational design study was conducted at a Thai tertiary care hospital. A total of 208 geriatric patients underwent cognitive function assessment via the Thai Mental State Examination (TMSE). Self-reported pain scores (using the verbal descriptor scale [VDS] and Numerical Rating Scale [NRS]) and PAINAD-Th scores were recorded in the postanesthetic care unit and on the first postoperative day in the ward. The data analysis focused on the concurrent validity of self-report pain scales and the PAINAD-Th, and the latter’s sensitivity in detecting pain reduction following analgesic treatment. The mean patient age was 77.6 years, and the mean TMSE score was 23.9. A strong correlation existed between the VDS and the PAINAD-Th scores in both cognitively impaired and cognitively intact patients (0.876 and 0.696, respectively; p  < 0.001). The NRS and PAINAD-Th scores were moderately correlated in patients with mild to moderate cognitive impairment and intact cognition (0.58 and 0.63, respectively; p  < 0.001). Importantly, both the PAINAD-Th and NRS scores decreased significantly following analgesic administration. The PAINAD-Th is a useful alternative pain assessment tool for the postoperative pain management of geriatric patients. This holds true for both cognitively impaired and intact patients who may struggle to provide self-reported pain scores.

The purpose of this study was to describe differences in treatment of White versus Black older adults, males versus females, and those living at home, assisted living, or nursing home communities with regard to the use of psychotropic, pain, and cardiovascular medications. Baseline data from the first 352 participants in the study, implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle, were used. Data included age, gender, race, comorbidities, admission diagnosis, and living location prior to hospitalization, the Saint Louis University Mental Status exam, the modified Charlson Comorbidity Index, the Pain Assessment in Advanced Dementia scale, the Confusion Assessment Method, and medications prescribed. Generalized linear mixed model analyses were done, controlling for race or gender (depending on which comparison analysis was being done), age, cognitive status, hospital, delirium, and comorbidities. Medication use was significantly higher for White older adults, compared to Black older adults, for antidepressants, anxiolytics, non-opioid pain medications, and opioids and lower for antihypertensives. Females received more anxiolytics than their male counterparts. There were differences in medication use by living location with regard to non-opioid pain medication, antipsychotics, statins, and anticoagulants. The findings provide some current information about differences in medication use across groups of individuals and can help guide future research and hypothesis testing for approaches to minimizing these differences in treatment.

To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance. Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID). One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT. Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.