Drug induced hyperactive delirium in older people hospitalised in emergency unit

Abstract

Delirium is a serious public health problem whose etiology is multifactorial. Pharmacotherapy is a modifiable risk factor. Our aim is to assess whether pharmacotherapy-related problems may induce hyperactive delirium in hospitalized elderly. A cross-sectional study will be conducted. Eligible patients will include those admitted at the internal medicine of the emergency unit of a teaching hospital in 2018, aged e 60 years and with length hospital stay e 24 hours. The screening of the elderly with hyperactive delirium will be performed by: 1) chart review; 2) trigger "hospital antipsychotic prescription" and 3) trigger "10th International Code of Diseases" (F05, R41, F11, F13, F15, F19). Pharmacotherapy review will include: treatment complexity, deliriogenic and anticholinergic burden, prescribing adequacy criteria for the elderly, polypharmacy prescribing, the occurrence of pharmacotherapy-related problems, and analysis of the causal association between drug use and the occurrence of the disorder. Sociodemographic, clinical, therapeutic, and laboratory variables will be collected to identify independent risk factors for drug-induced hyperactive delirium. Adverse events arising from the off-label use of antipsychotics for delirium treatment will be described. The positive predictive value of screening strategies will be calculated to identify the best performing delirium detection. (AU)