Screening for delirium within the interRAI acute care assessment system

Area of Science:

• Geriatric Medicine
• Clinical Assessment Tools
• Psychiatry

Background:

• Delirium is a common and serious condition in older adults admitted to acute care.
• Early and accurate detection of delirium is crucial for timely intervention and improved patient outcomes.
• Existing screening methods may have limitations in diverse acute care settings.

Purpose of the Study:

• To develop and validate a delirium screening strategy using the interRAI acute care (AC) comprehensive assessment system.
• To assess the accuracy of the developed screening strategy in older patients admitted to acute medical wards.

Main Methods:

• Prospective validation cohort study involving 239 subjects aged 70 and older.
• Utilized the interRAI AC system with four observational delirium items (Acute change mental status from baseline, mental function varies over the day, episode of disorganised speech, easily distracted).
• Compared the interRAI AC delirium screener algorithm against a reference standard diagnosis determined by geriatricians using DSM-IV criteria.

Main Results:

• Delirium was diagnosed in 21.7% of subjects.
• The interRAI-AC delirium screener algorithm achieved an area under the receiver operator characteristics (AUC) of 0.87, with 82% sensitivity and 91% specificity.
• The screening strategy remained valid even in patients with underlying pre-morbid cognitive impairment (AUC 0.85).

Conclusions:

• The interRAI AC delirium screening strategy is a valid and accurate tool for identifying delirium in older patients in acute medical settings.
• The developed screening strategy demonstrates high predictive accuracy, outperforming combinations of individual delirium features.
• This tool can aid in the early detection and management of delirium in elderly inpatients.