Examining the Risk of Delirium Among Residents with Diabetes in Long-Term Care Homes Across Ontario
Keywords:
Diabetes, delirium, older person, long-term care, Ontario
Abstract
Aim: To examine risk factors for delirium in residents with diabetes in Ontario’s LTC homes. 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 the mitigation of delirium in this population. Methods: A population-based retrospective analysis of the RAI-MDS dataset (2019–2020) was conducted. Findings: Diabetes was associated with a statistically significant increased risk of delirium (Odds Ratio: 1.073, CI 1.038–1.109), compounded by polypharmacy. Conclusions: Comprehensive delirium mitigation strategies are needed for this vulnerable population. Strategies to mitigate delirium in this population should be implemented.
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References
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6. 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 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
7. 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
8. 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
9. 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
10. 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
11. 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.
12. 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
13. 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
14. Iglseder, B., Frühwald, T., & Jagsch, C. (2022). Delirium in geriatric patients. Wiener Medizinishche Wochenschrift, 172, 114–12. https://doi.org/10.1007/s10354-021-00904-z
15. 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
16. 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
17. 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
18. 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
19. 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.
20. 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.
21. 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 motorsubtypes in the intensive care unit: a systematic scoping review. Critical care, 26(1), 53. https://doi.org/10.1186/s13054-022-03931-3
22. 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
23. 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
24. 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
25. 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
26. Minimum data set (MDS)-version 2.0 (2000). Minimum data set. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS20MDSAllForms.pdf
27. 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
28. Mordarska, K., & Godziejewska-Zawada, M. (2017). Diabetes in the elderly. Menopause Review/Przegląd Menopauzalny, 16(2), 38-43. doi:10.5114/pm.2017.68589
29. NICE (2022). Type 2 diabetes in adults: Management. https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493
30. 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.
31. 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
32. 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
33. 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
34. 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
35. 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
36. 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
37. 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.
38. 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.
39. 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 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
5. 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
6. 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 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
7. 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
8. 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
9. 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
10. 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
11. 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.
12. 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
13. 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
14. Iglseder, B., Frühwald, T., & Jagsch, C. (2022). Delirium in geriatric patients. Wiener Medizinishche Wochenschrift, 172, 114–12. https://doi.org/10.1007/s10354-021-00904-z
15. 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
16. 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
17. 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
18. 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
19. 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.
20. 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.
21. 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 motorsubtypes in the intensive care unit: a systematic scoping review. Critical care, 26(1), 53. https://doi.org/10.1186/s13054-022-03931-3
22. 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
23. 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
24. 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
25. 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
26. Minimum data set (MDS)-version 2.0 (2000). Minimum data set. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS20MDSAllForms.pdf
27. 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
28. Mordarska, K., & Godziejewska-Zawada, M. (2017). Diabetes in the elderly. Menopause Review/Przegląd Menopauzalny, 16(2), 38-43. doi:10.5114/pm.2017.68589
29. NICE (2022). Type 2 diabetes in adults: Management. https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493
30. 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.
31. 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
32. 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
33. 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
34. 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
35. 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
36. 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
37. 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.
38. 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.
39. 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
2025-02-28
How to Cite
Heale, R., Gorham, R., Rietze, L., & Hill, L. (2025). Examining the Risk of Delirium Among Residents with Diabetes in Long-Term Care Homes Across Ontario. European Scientific Journal, ESJ, 21(6), 1. https://doi.org/10.19044/esj.2025.v21n6p1
Section
ESJ Natural/Life/Medical Sciences
Copyright (c) 2025 Roberta Heale, Robyn Gorham, Lori Rietze, Laura Hill
This work is licensed under a Creative Commons Attribution 4.0 International License.
