Prospective Randomised Controlled Trial of Delirium Management by Geriatric Medicine Versus General Medicine
Palabras clave
Abstracto
Descripción
Delirium research has been stuck in 1990 with the CAM. Articles appearing in 2012 could have been written in 1990. The CAM is riddled with logical fallacies such as 1) Circular reasoning about hearing loss causing delirium - hearing loss causes incorrect answers to questions on orientation and attention, leading to false positive diagnosis of delirium; 2) Circular reasoning on dementia causing delirium - dementia often does cause delirium but behavioral and psychological symptoms of delirium (BPSD) are the most common false positive diagnosis of delirium. CADIS (Central Coast Australia Delirium Intervention Study) will compare CAM+ to CAM- age 65+ in emergency department (prevalent delirium). Paul Regal has already shown that the 8% of 630 elderly he admitted from January 2011 to June 2012 who were CAM+ had the same survival (hospital, 90 day, 180 day and 12 month) and return home rate (65%) as 580 CAM negative elderly. The Regal criteria for delirium are completely novel. For every error in questions, the Regal system forces the examiner to determine if the error is due to poor hearing or cognitive impairment. A portable amplifier with headphones is used. The Regal methods uses recent records as the baseline for attention, memory and orientation questions. For example, an 83 year-old woman was assessed in memory clinic and had digit span forward 5/5 and 5/6; 5-word recall at 5 minutes in MoCA was 4/5; orientation was 10/10. Two months later she is admitted for RLL pneumonia and confusion. Digit span declined by 40% to 3/5, 5-word recall at 5 minutes declined by 100% to 0/5 and orientation declined by 40% to 6/10. There was no event during the two months such as stroke to explain this decline.
Another novel feature of CADIS is follow-up by a blinded clinical nurse consultant at 30 and 90 days, 12 and 24 months for MoCA, Addenbrooke Cognitve Assessment and four tests from CANTABeclipse (Cambridge Cognition) touchscreen laptop. The hypothesis is that "persistent delirium" is due primarily to irreverible brain events such as ischemic stroke.
fechas
Verificado por última vez: | 06/30/2012 |
Primero enviado: | 07/09/2012 |
Inscripción estimada enviada: | 07/23/2012 |
Publicado por primera vez: | 07/25/2012 |
Última actualización enviada: | 07/23/2012 |
Última actualización publicada: | 07/25/2012 |
Fecha de inicio real del estudio: | 06/30/2012 |
Fecha estimada de finalización primaria: | 06/30/2014 |
Fecha estimada de finalización del estudio: | 06/30/2016 |
Condición o enfermedad
Intervención / tratamiento
Other: Geriatric Medicine
Fase
Grupos de brazos
Brazo | Intervención / tratamiento |
---|---|
No Intervention: General Medicine | |
Active Comparator: Geriatric Medicine Daily medical review, adjust medications, treat infection, occupational therapy | Other: Geriatric Medicine Adjust medications, treat precipitants of delirium, one-on-one supervision of agitated violent patients |
Criterio de elegibilidad
Edades elegibles para estudiar | 65 Years A 65 Years |
Sexos elegibles para estudiar | All |
Acepta voluntarios saludables | si |
Criterios | Inclusion Criteria: age 65+ medical admissions from emergency department with CAM positive delirium who have an informant / caregiver - Exclusion Criteria: 1)Aphasia; 2) Unable to speak English; 3) End stage dementia; 4) Terminal care; 5) No close informant; 6) Unable to hear questions with or without portable amplifier with headphones; 7) Intensive care; 8) Surgical admissions - |
Salir
Medidas de resultado primarias
1. Return home rate [10-50 days]
2. Survival [30, 90, 180 days, 12 and 24 month]
3. Percentage residing at home [30, 90 and 180 days, 12 and 24 months]
4. Hospital complications of delirium [7-50 days from admission]