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Letters to the Editor 2 Fujii M, Sato T, Ohrui T, Sato T, Sasaki H. Interanal stool bag for the bedridden elderly with pressure ulcer. Geriatr Gerontol Int 2004; 4: 120–122. 3 Takahashi M, Shirai S, Sawayama C et al. Constipation and aspiration pneumonia. Geriatr Gerontol Int 2012; 12: 570–571.
4 Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198. 5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington DC: American Psychiatric Association, 1994.
COMMENTS
Incident delirium from interdisciplinary team care Dear Editor, The article by Yoo et al.1 is a valuable addition to the delirium literature. I applaud the authors for searching medical records for a past diagnosis of dementia or mild cognitive impairment. The authors did not mention prevalent delirium as an exclusion factor – could they clarify whether they excluded prevalent delirium? They recruited patients over a period of 20 weeks in 2007. Recruitment 6 years ago might in part explain the unexpected high rate of incident delirium (94/518 or 18.1%). A more likely explanation is that behavioral and psychological symptoms of dementia (BPSD) were counted as delirium. From January 2011 to March 2013, I admitted 896 age ≥65 years acute geriatric admissions: 69 (7.7%) had prevalent Confusion Assessment Method (CAM)+ delirium and 23 (2.6%) had incident CAM+ delirium. Could Yoo et al. report the number and proportions of patients in each group who went to permanent highlevel care as opposed to skilled nursing homes? The authors could improve their study if they had measured the following: (i) hearing, assessed with the whisper test;2 (ii) if hearing was impaired despite hearing aids, to use a portable amplifier with headphones3 (cost US$100 with no consumables other than replacing batteries); (iii) inattention, by formal tests, such as five and six digit span forward;3 (iv) serum albumin, leukocyte count and neutrophil counts, as powerful predictors of discharge mortality; (v) instrumental activities of daily living (IADL).4 This is a better measure of cognitive recovery than ADL;4 and (vi) serial cognitive testing at discharge, 6 and 12 months. I recommend the Montreal Cognitive Assessment over the Mini-Mental State Examination.
© 2014 Japan Geriatrics Society
I am the principal investigator in the Central Coast Australia Delirium Intervention Study (CADIS). This is a prospective randomized controlled trial registered with Clinical Trials.Gov NCT01650896. CADIS compares CAM+ and CAM– subjects, as well as subjects positive and negative by a new diagnostic criteria I devised. CADIS also compares management of prevalent delirium by geriatricians in an acute geriatric unit with that of general internists outside the geriatric unit.
Disclosure statement The authors declare no conflict of interest. Paul Regal University of Newcastle, Lake Haven, New South Wales, Australia
References 1 Yoo JW, Nakagawa S, Kim S. Delirium and transition to a nursing home of hospitalized older adults: a controlled trial of assessing the interdisciplinary team-based “geriatric” care and care coordination by non-geriatrics specialist physicians. Geriatr Gerontol Int 2013; 13: 342–350. 2 Regal P. Hearing impairment, amplifiers and digit span. Am J Geriatr Psychiatry 2013; 21: doi:10/1016/j.jagp.2012.08.019. 3 Regal P. Confusion Assessment Method (CAM) indicators when CAM positivity in 647 patients has good outcome. J Am Geriatr Soc 2013; 61: 173. 4 Regal P, Hetherington E. Baseline IADL and incident dementia. J Am Geriatr Soc 2012; 60: 1189–1190.
doi: 10.1111/ggi.12120
| 235
Letters to the Editor 2 Fujii M, Sato T, Ohrui T, Sato T, Sasaki H. Interanal stool bag for the bedridden elderly with pressure ulcer. Geriatr Gerontol Int 2004; 4: 120–122. 3 Takahashi M, Shirai S, Sawayama C et al. Constipation and aspiration pneumonia. Geriatr Gerontol Int 2012; 12: 570–571.
4 Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198. 5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington DC: American Psychiatric Association, 1994.
COMMENTS
Incident delirium from interdisciplinary team care Dear Editor, The article by Yoo et al.1 is a valuable addition to the delirium literature. I applaud the authors for searching medical records for a past diagnosis of dementia or mild cognitive impairment. The authors did not mention prevalent delirium as an exclusion factor – could they clarify whether they excluded prevalent delirium? They recruited patients over a period of 20 weeks in 2007. Recruitment 6 years ago might in part explain the unexpected high rate of incident delirium (94/518 or 18.1%). A more likely explanation is that behavioral and psychological symptoms of dementia (BPSD) were counted as delirium. From January 2011 to March 2013, I admitted 896 age ≥65 years acute geriatric admissions: 69 (7.7%) had prevalent Confusion Assessment Method (CAM)+ delirium and 23 (2.6%) had incident CAM+ delirium. Could Yoo et al. report the number and proportions of patients in each group who went to permanent highlevel care as opposed to skilled nursing homes? The authors could improve their study if they had measured the following: (i) hearing, assessed with the whisper test;2 (ii) if hearing was impaired despite hearing aids, to use a portable amplifier with headphones3 (cost US$100 with no consumables other than replacing batteries); (iii) inattention, by formal tests, such as five and six digit span forward;3 (iv) serum albumin, leukocyte count and neutrophil counts, as powerful predictors of discharge mortality; (v) instrumental activities of daily living (IADL).4 This is a better measure of cognitive recovery than ADL;4 and (vi) serial cognitive testing at discharge, 6 and 12 months. I recommend the Montreal Cognitive Assessment over the Mini-Mental State Examination.
© 2014 Japan Geriatrics Society
I am the principal investigator in the Central Coast Australia Delirium Intervention Study (CADIS). This is a prospective randomized controlled trial registered with Clinical Trials.Gov NCT01650896. CADIS compares CAM+ and CAM– subjects, as well as subjects positive and negative by a new diagnostic criteria I devised. CADIS also compares management of prevalent delirium by geriatricians in an acute geriatric unit with that of general internists outside the geriatric unit.
Disclosure statement The authors declare no conflict of interest. Paul Regal University of Newcastle, Lake Haven, New South Wales, Australia
References 1 Yoo JW, Nakagawa S, Kim S. Delirium and transition to a nursing home of hospitalized older adults: a controlled trial of assessing the interdisciplinary team-based “geriatric” care and care coordination by non-geriatrics specialist physicians. Geriatr Gerontol Int 2013; 13: 342–350. 2 Regal P. Hearing impairment, amplifiers and digit span. Am J Geriatr Psychiatry 2013; 21: doi:10/1016/j.jagp.2012.08.019. 3 Regal P. Confusion Assessment Method (CAM) indicators when CAM positivity in 647 patients has good outcome. J Am Geriatr Soc 2013; 61: 173. 4 Regal P, Hetherington E. Baseline IADL and incident dementia. J Am Geriatr Soc 2012; 60: 1189–1190.
doi: 10.1111/ggi.12120
| 235
