Delirium screening and management in inpatient rehabilitation facilities

Delirium is an acute and fluctuating disturbance in cognition attention, and awareness that is often a reflection of abnormal physiological condition of an individual. Delirium is highly prevalent among an older population and is associated with high mortality, poor medical and functional outcomes and high healthcare cost. Delirium often has iatrogenic triggers and it has been recognized as a quality indicator of healthcare organizations. In spite of its high prevalence and significance, more than 50% of the delirium cases are underrecognized by healthcare professionals and remained untreated. Majority of patients in inpatient rehabilitation facilities are older adults with multiple risk factors for delirium including operation, intensive care stay, multiple comorbidities, and impaired mobility. Early detection, intervention as well as primary prevention of delirium will allow patients to avoid additional morbidities and reach their maximum functional potential during their rehabilitation stay. After the systematic implementation of delirium screening in our inpatient rehabilitation facility, we found that 10.3% of patients were screened positive for delirium at admission. This review discusses the systematic implementation of screening and intervention for delirium as well as the epidemiology of delirium to increase the awareness and guide clinical practice for clinicians in inpatient rehabilitation facilities. Financial support: MO-P, PC, OB and AMB were supported by the Kessler Foundation and Wallerstein Foundation for Geriatric Improvement and by the American Heart Association (PI: Boukrina 17SDG33660442) and the New Jersey Brain Injury Commission (PI: Barrett, grant CBIR16IRG041). Corresponding author: Mooyeon Oh-Park, M.D., Address: Burke Rehabilitation Hospital, White Plains, New York, 10605. U.S.A., Email: mohpark@burke.org Acknowledgments: The authors thank Anthony Lee, M.D. and Neil Jasey, MD for assisting in staff delirium care training. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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