A Description of the Risk for Delirium in Residents Living with Diabetes in Long-Term Care Homes Across Ontario
Keywords:
Diabetes, Delirium, Older Person, Long-Term Care, Ontario
Abstract
Aim: The aim of this study was to explore risk factors of delirium for residents with diabetes in LTC in Ontario. Scope: Residents in long term care (LTC) are vulnerable to negative outcomes related to diabetes, including delirium. Understanding factors related to the risk of delirium for residents with diabetes provides the foundation for mitigation of delirium in this population. Methods: A population-based retrospective secondary analysis was conducted using a dataset from the Resident Assessment Instrument – Minimum Data Set of residents living in LTC settings in Ontario between April 1, 2019, and March 31, 2020. Findings: Results showed that delirium was significantly associated with diabetes. Additionally, residents with diabetes had a higher occurrence of other delirium risk factors, including behavioural symptoms of dementia and the use of multiple medications, such as analgesics and psychotropic medications. Conclusions: Strategies to mitigate delirium in this population should be implemented.
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References
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7. Canadian Institute for Health Information (2002). Minimum data set 2.0 (Canadian version). https://secure.cihi.ca/estore/productSeries.htm?pc=PCC899
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11. Chavda, V. P., Ajabiya, J., Teli, D., Bojarska, J., & Apostolopoulos, V. (2022). Tirzepatide, a new era of dual-targeted treatment for diabetes and obesity: a mini-review. Molecules, 27(13), 4315. https://doi.org/10.3390/molecules27134315
12. Fong, T.G., Davis, D., Growdon, M.E., Albuquerque, A. & Inouye, S.K. (2015). The interface between delirium and dementia in elderly adults. The Lancet Neurology, 14(8), 823-832. doi:10.1016/S1474-4422(15)00101-5
13. Fortini, A., Morettini, A., Tavernese, G., Facchini, S., Tofani, L. & Pazzi, M. (2014). Delirium in elderly patients hospitalized in internal medicine wards. Internal and Emergency Medicine, 9, 435-441 doi:10.1007/s11739-013-0968-0
14. Friedrich, M. E., Grohmann, R., Rabl, U., Winkler, D., Konstantinidis, A., Engel, R., ... & Kasper, S. (2022). Incidence of Drug-Induced Delirium During Treatment With Antidepressants or Antipsychotics: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2016. International Journal of Neuropsychopharmacology, 25(7), 556-566.
15. Gagliardi, J.P., (2008). Differentiating among depression, delirium, and dementia in elderly patients. AMA Journal of Ethics, 10(6), 383-388. doi:10.1001/virtualmentor.2008.10.6.cprl1-0806
16. Inouye S.K., Westendorp R.G., & Saczynski J.S. (2014). Delirium in elderly people. The Lancet., 383(9920), 911-922. doi:10.1016/S0140-6736(13)60688-1
17. Iglseder, B., Frühwald, T. & Jagsch, C. (2022). Delirium in geriatric patients. Wien Med Wochenschr 172, 114–12. https://doi.org/10.1007/s10354-021-00904-z
18. Kalish, V.B., Gillham, J.E. & Unwin, B.K. (2014). Delirium in older persons: evaluation and management. American Family Physician, 90(3), 150-158. PMID: 25077720
19. Kim, D. E., & Yoon, J. Y. (2020). Factors that influence sleep among residents in long-term care facilities. International Journal of Environmental Research and Public Health, 17(6), 1889. https://doi.org/10.3390/ijerph17061889
20. Kotfis, K., Szylińska, A., Listewnik, M., Brykczyński, M., Ely, E.W. & Rotter, I. (2019). Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study. Neuropsychiatric disease and treatment, 15, 511-521. https://www.tandfonline.com/doi/full/10.2147/NDT.S196973
21. Kotfis, K., van Diem-Zaal, I., Roberson, S. W., Sietnicki, M., van den Boogaard, M., Shehabi, Y., & Wesley Ely, E., (2022). The future of intensive care: Delirium should no longer be an issue. Critical Care, 26 (200), 1-11. https://doi.org/10.1186/s13054-022-04077-y
22. Leon-Salas, B., Trujillo-Martin, M. M., Del Castillo, L. P. M., García, J. G., Pérez-Ros, P., Ruiz, F. R., & Serrano-Aguilar, P. (2020). Pharmacologic interventions for prevention of delirium in hospitalized older people: a meta-analysis. Archives of Gerontology and Geriatrics, 90, 104171.
23. Lopes, R. & Pereira, B.D. (2018). Delirium and psychotic symptoms associated with hyperglycemia in a patient with poorly controlled type 2 diabetes mellitus. Innovations in Clinical Neuroscience, 15(5-6), 30. PMID: 30013817
24. la Cour, K.N., Andersen-Ranberg, N.C., Weihe, S., Poulsen, L.M., Mortensen, C.B., Kjer, C.K., Collet, M.O., Estrup, S. & Mathiesen, O. (2022). Distribution of delirium motor subtypes in the intensive care unit: a systematic scoping review. Critical care, 26(1), 53. https://doi.org/10.1186/s13054-022-03931-3
25. McCarthy, C. E. (2021). Sleep disturbance, sleep disorders and co-morbidities in the care of the older person. Medical Sciences, 9(2), 31. https://doi.org/10.3390/medsci9020031
26. McCusker, J., Cole, M.G., Voyer, P., Vu, M., Ciampi, A., Monette, J., Champoux, N., Belzile, E. & Dyachenko, A. (2013). Environmental factors predict the severity of delirium symptoms in long‐term care residents with and without delirium. Journal of the American Geriatrics Society, 61(4), 502-511. doi:10.1111/jgs.12164
27. Meneilly, G.S. (2018). Diabetes and Dementia in the Elderly. Canadian Journal of Diabetes, 42(6), 579. doi:10.1016/j.jcjd.2018.10.0061
28. Meneilly G.S., Knip, A., Miller, D.B. Sherifali, D., Tessier, D. & Zahedi, A. (2018). Diabetes in older people. Canadian Journal of Diabetes, 42, S283-S295. https://guidelines.diabetes.ca/cpg/chapter37
29. Minimum data set (MDS)-version 2.0 (2000). (Online) https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS20MDSAllForms.pdf
30. Moon, K.J. & Park, H. (2018). Outcomes of patients with delirium in long-term care facilities: A prospective cohort study. Journal of Gerontological Nursing, 44(9), 41-50. doi:10.3928/00989134-20180808-08
31. Mordarska, K. & Godziejewska-Zawada, M. (2017). Diabetes in the elderly. Menopause Review/Przegląd Menopauzalny, 16(2), 38-43. doi:10.5114/pm.2017.68589
32. NICE (2022). Type 2 diabetes in adults: management. https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493
33. Ormseth, C.H., LaHue, S.C., Oldham, M.A., Josephson, S.A., Whitaker, E. & Douglas, V.C. (2023). Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review. JAMA Network Open, 6(1), e2249950-e2249950.
34. Osman, O., Sherifali, D., Stolee, P. & Heckman, G. (2015). Diabetes management in long-term care: An exploratory study of the current practices and processes to managing frail elderly persons with type 2 diabetes. Canadian Journal of Diabetes, 40, 17-30. http://dx.doi.org/10.1016/j.jcjd.2015.10.005
35. Punthakee, Z., Goldenberg, R. & Katz, P. (2018). Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Canadian journal of diabetes, 42, S10-S15. doi:10.1016/j.jcjd.2017.10.003
36. Quinlan, N., Marcantonio, E.R., Inouye, S.K., Gill, T.M., Kamholz, B. & Rudolph, J.L. (2011). Vulnerability: the crossroads of frailty and delirium. Journal of the American Geriatrics Society, 59, S262-S268. doi:10.1111/j.1532-5415.2011.03674.x
37. Registered Nurses Association of Ontario (2016). Delirium, dementia, and depression in older adults: Assessment and care (Best Practice Guideline). https://rnao.ca/sites/rnao-ca/files/3Ds_BPG_WEB_FINAL.pdf
38. Song, Y., Hoben, M., Weeks, L., Boström, A.M., Goodarzi, Z.S., Squires, J., Doan, H., Wagg, A., Reid, R.C. & Estabrooks, C. (2019). Factors associated with the responsive behaviours of older adults living in long-term care homes towards staff: a systematic review protocol. Bmj Open, 9(5), e028416. doi:10.1136/bmjopen-2018-028416
39. Stollings, J. L., Kotfis, K., Chanques, G., Pun, B. T., Pandharipande, P. P., & Ely, E. W. (2021). Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive care medicine, 47(10), 1089–1103. https://doi.org/10.1007/s00134-021-06503-1
40. van Keulen, K., Knol, W., Belitser, S. V., Zaal, I. J., van der Linden, P. D., Heerdink, E. R., …& Slooter, A. J. (2018). Glucose variability during delirium in diabetic and non-diabetic intensive care unit patients: a prospective cohort study. PLoS One, 13(11), e0205637.
41. van Loveren, K., Singla, A., Sinvani, L., Calandrella, C., Perera, T., Brave, M., ... & Li, T. (2021). Increased emergency department hallway length of stay is associated with development of delirium. Western Journal of Emergency Medicine, 22(3), 726.
42. Watson, P.L., Ceriana, P. & Fanfulla, F. (2012). Delirium: is sleep important?. Best Practice and Research Clinical Anaesthesiology, 26(3), 355-366. doi:10.1016/j.bpa.2012.08.005
2. Ahmed, S., Leurent, B. & Sampson, E.L., (2014). Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age and ageing, 43(3), 326-333.
3. Altomare, F., Kherani, A., Lovshin, J. & Diabetes Canada Clinical Practice Guidelines Expert Committee (2018). Retinopathy. Canadian Journal of Diabetes, 42, S210-S216. doi:10.1016/j.jcjd.2017.10.027
4. American Diabetes Association (2023). Older adults: Standards of care. Diabetes Care, 46 (Suppl 1). S216–S229 | https://doi.org/10.2337/dc23-S013
5. ArcMap (2019). What they don't tell you about regression analysis. Retrieved from https://desktop.arcgis.com/en/arcmap/10.7/tools/spatial-statistics-toolbox/what-they-don-t-tell-you-about-regression-analysis.htm#:~:text=Typically%20you%20will%20remove%20explanatory,if%20it%27s%20not%20statistically%20significant.
6. Berra, C., De Fazio, F., Azzolini, E., Albini, M., Zangrandi, F., Mirani, M., Garbossa, S., Guardado-Mendoza, R., Condorelli, G. & Folli, F (2019). Hypoglycemia and hyperglycemia are risk factors for falls in the hospital population. Acta diabetologica, 56, 931-938. doi:10.1007/s00592-019-01323-8
7. Canadian Institute for Health Information (2002). Minimum data set 2.0 (Canadian version). https://secure.cihi.ca/estore/productSeries.htm?pc=PCC899
8. Canadian Institute for Health Information (2013). Privacy Policy on the Collection, Use, Disclosure, and Retention of Personal Health Information and De-Identified Data, 2010. Retrieved from: https://secure.cihi.ca/free_products/Privacy%20Policy2013_EN_Web.pdf
9. Canadian Institute for Health Information. [CIHI] (October 13, 2022). Canadian COVID-19 Intervention Timeline. Retrieved from: https://www.cihi.ca/en/canadian-covid-19-intervention-timeline
10. Centers for Medicare and Medicaid Services (CMMS) (2005). Revised long-term care facility resident assessment instrument user’s manual, version 2.0 https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MinimumDataSets20/Downloads/RAI-Manual-Table-of-Contents.pdf
11. Chavda, V. P., Ajabiya, J., Teli, D., Bojarska, J., & Apostolopoulos, V. (2022). Tirzepatide, a new era of dual-targeted treatment for diabetes and obesity: a mini-review. Molecules, 27(13), 4315. https://doi.org/10.3390/molecules27134315
12. Fong, T.G., Davis, D., Growdon, M.E., Albuquerque, A. & Inouye, S.K. (2015). The interface between delirium and dementia in elderly adults. The Lancet Neurology, 14(8), 823-832. doi:10.1016/S1474-4422(15)00101-5
13. Fortini, A., Morettini, A., Tavernese, G., Facchini, S., Tofani, L. & Pazzi, M. (2014). Delirium in elderly patients hospitalized in internal medicine wards. Internal and Emergency Medicine, 9, 435-441 doi:10.1007/s11739-013-0968-0
14. Friedrich, M. E., Grohmann, R., Rabl, U., Winkler, D., Konstantinidis, A., Engel, R., ... & Kasper, S. (2022). Incidence of Drug-Induced Delirium During Treatment With Antidepressants or Antipsychotics: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2016. International Journal of Neuropsychopharmacology, 25(7), 556-566.
15. Gagliardi, J.P., (2008). Differentiating among depression, delirium, and dementia in elderly patients. AMA Journal of Ethics, 10(6), 383-388. doi:10.1001/virtualmentor.2008.10.6.cprl1-0806
16. Inouye S.K., Westendorp R.G., & Saczynski J.S. (2014). Delirium in elderly people. The Lancet., 383(9920), 911-922. doi:10.1016/S0140-6736(13)60688-1
17. Iglseder, B., Frühwald, T. & Jagsch, C. (2022). Delirium in geriatric patients. Wien Med Wochenschr 172, 114–12. https://doi.org/10.1007/s10354-021-00904-z
18. Kalish, V.B., Gillham, J.E. & Unwin, B.K. (2014). Delirium in older persons: evaluation and management. American Family Physician, 90(3), 150-158. PMID: 25077720
19. Kim, D. E., & Yoon, J. Y. (2020). Factors that influence sleep among residents in long-term care facilities. International Journal of Environmental Research and Public Health, 17(6), 1889. https://doi.org/10.3390/ijerph17061889
20. Kotfis, K., Szylińska, A., Listewnik, M., Brykczyński, M., Ely, E.W. & Rotter, I. (2019). Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study. Neuropsychiatric disease and treatment, 15, 511-521. https://www.tandfonline.com/doi/full/10.2147/NDT.S196973
21. Kotfis, K., van Diem-Zaal, I., Roberson, S. W., Sietnicki, M., van den Boogaard, M., Shehabi, Y., & Wesley Ely, E., (2022). The future of intensive care: Delirium should no longer be an issue. Critical Care, 26 (200), 1-11. https://doi.org/10.1186/s13054-022-04077-y
22. Leon-Salas, B., Trujillo-Martin, M. M., Del Castillo, L. P. M., García, J. G., Pérez-Ros, P., Ruiz, F. R., & Serrano-Aguilar, P. (2020). Pharmacologic interventions for prevention of delirium in hospitalized older people: a meta-analysis. Archives of Gerontology and Geriatrics, 90, 104171.
23. Lopes, R. & Pereira, B.D. (2018). Delirium and psychotic symptoms associated with hyperglycemia in a patient with poorly controlled type 2 diabetes mellitus. Innovations in Clinical Neuroscience, 15(5-6), 30. PMID: 30013817
24. la Cour, K.N., Andersen-Ranberg, N.C., Weihe, S., Poulsen, L.M., Mortensen, C.B., Kjer, C.K., Collet, M.O., Estrup, S. & Mathiesen, O. (2022). Distribution of delirium motor subtypes in the intensive care unit: a systematic scoping review. Critical care, 26(1), 53. https://doi.org/10.1186/s13054-022-03931-3
25. McCarthy, C. E. (2021). Sleep disturbance, sleep disorders and co-morbidities in the care of the older person. Medical Sciences, 9(2), 31. https://doi.org/10.3390/medsci9020031
26. McCusker, J., Cole, M.G., Voyer, P., Vu, M., Ciampi, A., Monette, J., Champoux, N., Belzile, E. & Dyachenko, A. (2013). Environmental factors predict the severity of delirium symptoms in long‐term care residents with and without delirium. Journal of the American Geriatrics Society, 61(4), 502-511. doi:10.1111/jgs.12164
27. Meneilly, G.S. (2018). Diabetes and Dementia in the Elderly. Canadian Journal of Diabetes, 42(6), 579. doi:10.1016/j.jcjd.2018.10.0061
28. Meneilly G.S., Knip, A., Miller, D.B. Sherifali, D., Tessier, D. & Zahedi, A. (2018). Diabetes in older people. Canadian Journal of Diabetes, 42, S283-S295. https://guidelines.diabetes.ca/cpg/chapter37
29. Minimum data set (MDS)-version 2.0 (2000). (Online) https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS20MDSAllForms.pdf
30. Moon, K.J. & Park, H. (2018). Outcomes of patients with delirium in long-term care facilities: A prospective cohort study. Journal of Gerontological Nursing, 44(9), 41-50. doi:10.3928/00989134-20180808-08
31. Mordarska, K. & Godziejewska-Zawada, M. (2017). Diabetes in the elderly. Menopause Review/Przegląd Menopauzalny, 16(2), 38-43. doi:10.5114/pm.2017.68589
32. NICE (2022). Type 2 diabetes in adults: management. https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493
33. Ormseth, C.H., LaHue, S.C., Oldham, M.A., Josephson, S.A., Whitaker, E. & Douglas, V.C. (2023). Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review. JAMA Network Open, 6(1), e2249950-e2249950.
34. Osman, O., Sherifali, D., Stolee, P. & Heckman, G. (2015). Diabetes management in long-term care: An exploratory study of the current practices and processes to managing frail elderly persons with type 2 diabetes. Canadian Journal of Diabetes, 40, 17-30. http://dx.doi.org/10.1016/j.jcjd.2015.10.005
35. Punthakee, Z., Goldenberg, R. & Katz, P. (2018). Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Canadian journal of diabetes, 42, S10-S15. doi:10.1016/j.jcjd.2017.10.003
36. Quinlan, N., Marcantonio, E.R., Inouye, S.K., Gill, T.M., Kamholz, B. & Rudolph, J.L. (2011). Vulnerability: the crossroads of frailty and delirium. Journal of the American Geriatrics Society, 59, S262-S268. doi:10.1111/j.1532-5415.2011.03674.x
37. Registered Nurses Association of Ontario (2016). Delirium, dementia, and depression in older adults: Assessment and care (Best Practice Guideline). https://rnao.ca/sites/rnao-ca/files/3Ds_BPG_WEB_FINAL.pdf
38. Song, Y., Hoben, M., Weeks, L., Boström, A.M., Goodarzi, Z.S., Squires, J., Doan, H., Wagg, A., Reid, R.C. & Estabrooks, C. (2019). Factors associated with the responsive behaviours of older adults living in long-term care homes towards staff: a systematic review protocol. Bmj Open, 9(5), e028416. doi:10.1136/bmjopen-2018-028416
39. Stollings, J. L., Kotfis, K., Chanques, G., Pun, B. T., Pandharipande, P. P., & Ely, E. W. (2021). Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive care medicine, 47(10), 1089–1103. https://doi.org/10.1007/s00134-021-06503-1
40. van Keulen, K., Knol, W., Belitser, S. V., Zaal, I. J., van der Linden, P. D., Heerdink, E. R., …& Slooter, A. J. (2018). Glucose variability during delirium in diabetic and non-diabetic intensive care unit patients: a prospective cohort study. PLoS One, 13(11), e0205637.
41. van Loveren, K., Singla, A., Sinvani, L., Calandrella, C., Perera, T., Brave, M., ... & Li, T. (2021). Increased emergency department hallway length of stay is associated with development of delirium. Western Journal of Emergency Medicine, 22(3), 726.
42. Watson, P.L., Ceriana, P. & Fanfulla, F. (2012). Delirium: is sleep important?. Best Practice and Research Clinical Anaesthesiology, 26(3), 355-366. doi:10.1016/j.bpa.2012.08.005
Published
2024-11-26
How to Cite
Heale, R., Gorham, R., Rietze, L., & Hill, L. (2024). A Description of the Risk for Delirium in Residents Living with Diabetes in Long-Term Care Homes Across Ontario. European Scientific Journal, ESJ, 35, 543. Retrieved from https://eujournal.org/index.php/esj/article/view/18794
Section
ESI Preprints
Copyright (c) 2024 Roberta Heale, Robyn Gorham, Lori Rietze, Laura Hill
This work is licensed under a Creative Commons Attribution 4.0 International License.
