Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 “Delirium Day” project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P <.001), visual impairment (24.2% vs 15.7%; P <.01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P =.00] and in Model 2 (OR 1.4; CI 1.1–1.9; P =.02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P =.36; OR 1.1; CI 0.8–1.4; P =.42) or in Model 2 (OR 0.8, CI 0.6–1.2, P =.27; OR 1.1, CI 0.8–1.4, P =.63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.
Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study / Morandi, A.; Inzitari, M.; Udina, C.; Gual, N.; Mota, M.; Tassistro, E.; Andreano, A.; Cherubini, A.; Gentile, S.; Mossello, E.; Marengoni, A.; Olive, A.; Riba, F.; Ruiz, D.; de Jaime, E.; Bellelli, G.; Tarasconi, A.; Sella, M.; Auriemma, S.; Paterno, G.; Faggian, G.; Lucarelli, C.; De Grazia, N.; Alberto, C.; Margola, A.; Porcella, L.; Nardiello, I.; Chimenti, E.; Zeni, M.; Giani, A.; Famularo, S.; Romairone, E.; Minaglia, C.; Ceccotti, C.; Guerra, G.; Mantovani, G.; Monacelli, F.; Candiani, T.; Ballestrero, A.; Santolini, F.; Rosso, M.; Bono, V.; Sibilla, S.; Dal Santo, P.; Ceci, M.; Barone, P.; Schirinzi, T.; Formenti, A.; Nastasi, G.; Isaia, G.; Gonella, D.; Battuello, A.; Casson, S.; Calvani, D.; Boni, F.; Ciaccio, A.; Rosa, R.; Sanna, G.; Manfredini, S.; Cortese, L.; Rizzo, M.; Prestano, R.; Greco, A.; Lauriola, M.; Gelosa, G.; Piras, V.; Arena, M.; Cosenza, D.; Bellomo, A.; Lamontagna, M.; Gabbani, L.; Lambertucci, L.; Perego, S.; Parati, G.; Basile, G.; Gallina, V.; Pilone, G.; Giudice, C.; De, F.; Pietrogrande, L.; De, B.; Mosca, M.; Corazzin, I.; Rossi, P.; Nunziata, V.; D'Amico, F.; Grippa, A.; Giardini, S.; Barucci, R.; Cossu, A.; Fiorin, L.; Distefano, M.; Lunardelli, M.; Brunori, M.; Ruffini, I.; Abraham, E.; Varutti, A.; Fabbro, E.; Catalano, A.; Martino, G.; Leotta, D.; Marchet, A.; Dell'Aquila, G.; Scrimieri, A.; Davoli, M.; Casella, M.; Cartei, A.; Polidori, G.; Brischetto, D.; Motta, S.; Saponara, R.; Perrone, P.; Russo, G.; Del, D.; Car, C.; Pirina, T.; Franzoni, S.; Cotroneo, A.; Ghiggia, F.; Volpi, G.; Menichetti, C.; Bo, M.; Panico, A.; Calogero, P.; Corvalli, G.; Mauri, M.; Lupia, E.; Manfredini, R.; Fabbian, F.; March, A.; Pedrotti, M.; Veronesi, M.; Strocchi, E.; Borghi, C.; Bianchetti, A.; Crucitti, A.; Difrancesco, V.; Fontana, G.; Bonanni, L.; Barbone, F.; Serrati, C.; Ballardini, G.; Simoncelli, M.; Ceschia, G.; Scarpa, C.; Brugiolo, R.; Fusco, S.; Ciarambino, T.; Biagini, C.; Tonon, E.; Porta, M.; Venuti, D.; Delsette, M.; Poeta, M.; Barbagallo, G.; Trovato, G.; Delitala, A.; Arosio, P.; Reggiani, F.; Zuliani, G.; Ortolani, B.; Mussio, E.; Girardi, A.; Coin, A.; Ruotolo, G.; Castagna, A.; Masina, M.; Cimino, R.; Pinciaroli, A.; Tripodi, G.; Cannistra, U.; Cassadonte, F.; Vatrano, M.; Scaglione, L.; Fogliacco, P.; Muzzuilini, C.; Romano, F.; Padovani, A.; Rozzini, L.; Cagnin, A.; Fragiacomo, F.; Desideri, G.; Liberatore, E.; Bruni, A.; Orsitto, G.; Franco, M.; Bonfrate, L.; Bonetto, M.; Pizio, N.; Magnani, G.; Cecchetti, G.; Longo, A.; Bubba, V.; Marinan, L.; Cotelli, M.; Turla, M.; Sessa, M.; Abruzzi, L.; Castoldi, G.; Lovetere, D.; Musacchio, C.; Novello, M.; Cavarape, A.; Bini, A.; Leonardi, A.; Seneci, F.; Grimaldi, W.; Fimognari, F.; Bambara, V.; Saitta, A.; Corica, F.; Braga, M.; Ettorre, E.; Camellini, C.; Bellelli, G.; Annoni, G.; Crescenzo, A.; Noro, G.; Turco, R.; Ponzetto, M.; Giuseppe, L.; Mazzei, B.; Maiuri, G.; Costaggiu, D.; Damato, R.; Formilan, M.; Patrizia, G.; Gallucci, M.; Paragona, M.; Bini, P.; Modica, D.; Abati, C.; Clerici, M.; Barbera, I.; Nigroimperiale, F.; Manni, A.; Votino, C.; Castiglioni, C.; Di, M.; Degl'Innocenti, M.; Moscatelli, G.; Guerini, S.; Casini, C.; Dini, D.; D'Imporzano, E.; Denotariis, S.; Bonometti, F.; Paolillo, C.; Riccardi, A.; Tiozzo, A.; Dibari, M.; Vanni, S.; Scarpa, A.; Zara, D.; Ranieri, P.; Alessandro, M.; Di, F.; Pezzoni, D.; Platto, C.; D'Ambrosio, V.; Ivaldi, C.; Milia, P.; Desalvo, F.; Solaro, C.; Strazzacappa, M.; Cazzadori, M.; Confente, S.; Grasso, M.; Troisi, E.; Guerini, V.; Bernardini, B.; Corsini, C.; Boffelli, S.; Filippi, A.; Delpin, K.; Faraci, B.; Bertoletti, E.; Vannucci, M.; Tesi, F.; Crippa, P.; Malighetti, A.; Bettini, D.; Maltese, F.; Abruzzese, G.; Cosimo, D.; Azzini, M.; Colombo, M.; Procino, G.; Fascendini, S.; Barocco, F.; Del, P.; Mazzone, A.; Riva, E.; Dell'Acqua, D.; Cottino, M.; Vezzadini, G.; Avanzi, S.; Brambilla, C.; Orini, S.; Sgrilli, F.; Mello, A.; Lombardi, L.; Muti, E.; Dijk, B.; Fenu, S.; Pes, C.; Gareri, P.; Passamonte, M.; Rigo, R.; Locusta, L.; Caser, L.; Rosso, G.; Cesarini, S.; Cozzi, R.; Santini, C.; Carbone, P.; Cazzaniga, I.; Lovati, R.; Cantoni, A.; Ranzani, P.; Barra, D.; Pompilio, G.; Dimori, S.; Cernesi, S.; Ricco, C.; Piazzolla, F.; Capittini, E.; Rota, C.; Gottardi, F.; Merla, L.; Barelli, A.; Millul, A.; De, G.; Morrone, G.; Bigolari, M.; Macchi, M.; Zambon, F.; Pizzorni, C.; Dicasaleto, G.; Menculini, G.; Marcacci, M.; Catanese, G.; Sprini, D.; Dicasalet, T.; Bocci, M.; Borga, S.; Caironi, P.; Cat, C.; Cingolani, E.; Avalli, L.; Greco, G.; Citerio, G.; Gandini, L.; Cornara, G.; Lerda, R.; Brazzi, L.; Simeone, F.; Caciorgna, M.; Alampi, D.; Francesconi, S.; Beck, E.; Antonini, B.; Vettoretto, K.; Meggiolaro, M.; Garofalo, E.; Notaro, S.; Varutti, R.; Bassi, F.; Mistraletti, G.; Marino, A.; Rona, R.; Rondelli, E.; Riva, I.; Scapigliati, A.; Cortegiani, A.; Vitale, F.; Pistidda, L.; D'Andrea, R.; Querci, L.; Gnesin, P.; Todeschini, M.; Lugano, M.; Castelli, G.; Ortolani, M.; Cotoia, A.; Maggiore, S.; Ditizio, L.; Graziani, R.; Testa, I.; Ferretti, E.; Castioni, C.; Lombardi, F.; Caserta, R.; Pasqua, M.; Simoncini, S.; Baccarini, F.; Rispoli, M.; Grossi, F.; Cancelliere, L.; Carnelli, M.; Puccini, F.; Biancofiore, G.; Siniscalchi, A.; Laici, C.; Mossello, E.; Torrini, M.; Pasetti, G.; Palmese, S.; Oggioni, R.; Mangani, V.; Pini, S.; Martelli, M.; Rigo, E.; Zuccala, F.; Cherri, A.; Spina, R.; Calamai, I.; Petrucci, N.; Caicedo, A.; Ferri, F.; Gritti, P.; Brienza, N.; Fonnesu, R.; Dessena, M.; Fullin, G.; Saggioro, D.. - In: JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION. - ISSN 1525-8610. - 22:6(2021), pp. 1162-1167.e3. [10.1016/j.jamda.2020.09.032]
Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study
2021
Abstract
Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 “Delirium Day” project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P <.001), visual impairment (24.2% vs 15.7%; P <.01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P =.00] and in Model 2 (OR 1.4; CI 1.1–1.9; P =.02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P =.36; OR 1.1; CI 0.8–1.4; P =.42) or in Model 2 (OR 0.8, CI 0.6–1.2, P =.27; OR 1.1, CI 0.8–1.4, P =.63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.
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