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An Exploratory Study of Diagnostic Criteria for Delirium in Older Medical Inpatients

Received February 6, 2006; revised April 24, 2006; accepted May 15, 2006. Dr. Cole is affiliated with the Department of Psychiatry, St. Mary’s Hospital and McGill University, Montreal, Canada. Dr. McCusker is affiliated with the Department of Clinical Epidemiology and Community Studies, St. Mary’s Hospital and McGill University, Montreal. Dr. Ciampi is affiliated with the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal. Dr. Dyachenko is affiliated with the Department of Clinical Epidemiology and Community Studies, St. Mary’s Hospital Centre, Montreal. Address correspondence to Dr. Cole, Department of Psychiatry, St. Mary’s Hospital, 3830 avenue Lacombe, Montréal, Québec H3T 1M5; martin.cole{at}ssss.gouv.qc.ca (e-mail).

The poor prognosis of delirium in older medical inpatients has generated controversy about the diagnostic criteria for delirium in this population. The goal of the present study was to explore the presenting symptoms of delirium among older medical inpatients who did or did not recover from delirium. Patients 65 years or older admitted from the emergency department to medical services were screened with the Confusion Assessment Method (CAM). Patients with delirium were assessed at enrollment, several times during the first week, then weekly for 4 weeks using the Delirium Index (DI). Measures at baseline included demographics, dementia and severity of physical illness. Recovery was defined as a decline of three points or more on the DI and a final DI score of less than 5 or 4 points in patients with or without dementia, respectively. Of 290 patients who met DSM-IV criteria for delirium, 65 recovered and 225 did not. Three symptoms (orientation to person, hyperactivity, and inattention) were associated with recovery from delirium in older medical inpatients. These results suggest it may be necessary to place increased emphasis on these presenting symptoms when diagnosing delirium in this population.

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