臺灣博碩士論文加值系統

背景：譫妄常見於加護病房病人，而入住前病人有失智症情形發生譫妄的機率比未有失智症者高。加護病房病人若有譫妄，易造成預後差、住院天數延長、治療及呼吸器留置天數，醫療費用增加、感染率及死亡率增加，且譫妄的發生也易造成失智症更加嚴重或是演變為失智症。
目的：1) 比較加護病房失智和沒有失智病人在前置因子和誘發因子上的差異;2)比較入住加護病房前病人有無失智其譫妄發生率之差異；3)比較入住加護病房前病人有無失智併發譫妄的型態之差異；4)比較入住加護病房前病人有無失智產生譫妄加護病房的平均住院天數之差異；5)比較入住加護病房前病人有無失智產生譫妄加護病房的醫療費用之差異;6)比較加護病房病人是否發生譫妄在前置因子和誘發因子上的差異;7)探討加護病房發生譫妄與否之相關因素。
方法：本研究將採立意方便取樣，以雲嘉南某區域教學醫院成人加護病房(含內科加護病房、胸腔科加護病房、外科加護病房、心臟科加護病房)的個案為研究對象，以MMSE確認新入住個案入住前是否有失智症，無法執行認知評估的病人以IQCODE詢問病人家屬替代之，譫妄的評估是每日兩次(早上7點和下午5點)以加護病房急性混亂評估量表(CAM-ICU)評估，連續收集評估5天，共收案142位個案。
統計分析：本研究收集資料回收後，刪除無效問卷後，將問卷編碼並輸入電腦，以SPSS21.0統計軟體，進行資料分析，以平均值、標準差、百分比等呈現描述性統計，以獨立樣本t檢定(t-test)、卡方檢定(Chi-square)檢定、Fisher,s精確檢定(Fisher,s exact test)檢定、二元邏輯迴歸分析(Binary logistic regression)進行推論性統計，檢定加護病房發生失智發生譫妄及無失智發生譫妄兩組對加護病房住院天數、住院費用、呼吸器使用天數、導管使用天數、約束天數、譫妄發生天數的影響。
結果:142為個案中，1)失智有74人，其中70人發生譫妄；無失智有68人，其中37人發生譫妄，建立入住加護病房老人譫妄發生率94.6%；2)譫妄發生的型態上，都是以混合型譫妄最多(n=34, 45.9%, vs. n=19, 27.9%)，其次依序為低活動型譫妄(n=27, 36.5% vs. n=13, 19.1%)，和高活動型譫妄 (n=9, 12.2% vs. n=5, 7.4%)；3) 兩組加護病房病人入住的天數以3-4天最為常見 (n=32, 43.2% vs. 15, 22.1%)；4)在加護病房花費，無失智症併譫妄者加護病房花費平均為104480.24元(SD =101792.211)較失智併譫妄者78221.64元(SD =76716.640)花費高。
結論:加護病房病人譫妄發生率75.4%，若為失智症發生譫妄者病人高達94.6%，年齡、平日住於護理之家、轉入疾病嚴重程度分數、轉入昏迷分數、IQCODE分數、被身體約束者為顯著預測因子，文獻及研究中前置因子及誘發因子多重因素下，皆會導致有無失智病人發生譫妄的危險，臨床醫護人員需具備譫妄的相關知識、如何預防及治療，能提早評估並適時介入及發展譫妄相關的照護指引，都能降低病人的相關合併症、減少醫療照護時數及成本，進而提升臨床病人安全及品質。

Background: Delirium is common seen in patients at the intensive care units, and the risk of developing delirium in patients with dementia before admission is higher than that of patients without dementia at the intensive care units, Patients developing delirium can lead to poor prognosis, whiching including prolonged hospital stay, extended days of use of the respirator, increased medical costs, and even elevated infection and mortality rates. Also, the occurrence of delirium can worsen the level of dementia or involved into development of dementia.
Purpose: 1)Compare the differences between the predisposing risk factors and precipitating risk factors of patients with dementia and those without dementia at the intensive care units; 2) Compare the difference of the incidence rate of delirium between patients with dementia prior to the intensive care units and those without dementia;3) Compare the differences of the types of delirium between patients with dementia prior to the intensive care units and those without dementia;4) Compare the difference of the length of stay between patients with dementia prior to the intensive care units and those without dementia;5) Compare the difference of the medical costs between patients with dementia prior to the intensive care units and those without dementia;6) Compare of the difference of the predisposing risk factors and precipitating risk factors between patients developing delirium and those without delirium at intensive care units;7) Explore the related risk factors of delirium in intensive care units.
Methods: All the subjects were recruited from adult intensive care wards(including an intenal medicine intensive care unit, a respiratory intensive care unit, a surgical intensive care unit, and a cardiology intensive care unit), with a purposive sampling. The Mini-Mental State Examination was used to screen if the subject is demented, and the Informant Questionnaire on Cognitive Decline in the Elderly(IQCODE) was used to ask the subjects family for identifying those are dementia. Delirium was evaluated twice daily (7 am and 5 pm) with Confusion Assessment Method-ICU for continuous 5 days.
Statistical analysis: As the questionnaires were collected, all data was coded and analyzed by the SPSS21.0 statistical software. The descriptive statistics was presented with mean values, standard deviation, percentage, and more. The inferent stastistics such as the independent sample t test, the Chi-squared test, the Fisher,s exact test, and the binary logistic regression were used to examine the difference between two groups(with and without dementia) in the number of days of hospitalization, the number of days of ventilator use, the number of days of catheter use, the number of days of restraint, the number of days of delirium.
Results: Totoally, 142 subjects were involved in this study and dividevd into a group of patients with dementia (n=74, 70 of them developing delirium duriung the study), and the other group for patients who were not demented (n=68, 37 of them developing delirium). The incidence rate of delirium among elderly patients at intensive care units was established 75.4%, and the incidence rate for elderly patients superimposed on dementia was 94.6% in this study. The mixed type of delirium was the most seen in both groups(n = 34, 45.9%, vs. n = 19, 27.9%), respectively was the hypoactive type (n = 27, 36.5% vs. n = 13, 19.1%), and the hyperactive type(n = 9, 12.2% vs. n = 5, 7.4%). The length of stay for patients at the intensive care units ranged mostly from 3 to 4 days (n = 32, 43.2% vs. 15, 22.1%). The average medical cost in the demented group with delirium (mean=104,480.24 NT dollars, SD = 101792.211) was significant higher than the cost in the demented group without delirium (mean =78,221.64 NT dollars, SD = 76716.640).
Conclusion: Both incidence rates of delirium among elderly patients with or without dementia are very high (75.4%, &94.6%). Old age, stay at nursing homes prior to admission, scores of acute physiology and chronic health evaluation (APACHE Π), and IQCODE scores were significantly associated with the development of delirium, which reflecting to predisposing factors and precipitating factors identified in the literatrue and other research. The health care providers at clinics should have knowledge about and dementia, so that the development of delirium can be prevented at an ealier stage, the length of stay, and the medical cost may be decteased. Finally, the quality of care and patient safety can be improved.

誌謝...........................................I
中文摘要........................................II
Abstract.......................................IV
目次...........................................VII
表目次..........................................X
圖目次..........................................XI
第一章 緒論.....................................1
第一節 研究背景與重要性...........................1
第二節 研究目的..................................3
第三節 研究問題..................................4
第四節 研究假設..................................4
第五節名詞解釋...................................4
第二章 文獻探討..................................8
第一節 譫妄的定義與特徵...........................8
第二節 失智症的定義..............................10
第三節 譫妄病理生理機轉...........................11
第四節 影響譫妄前置因子和誘發因子..................12
第五節 譫妄的評估及測量...........................15
第六節 失智的評估及測量...........................19
第七節 失智合併譫妄的影響.........................23
第三章 研究方法..................................25
第一節 研究設計..................................25
第二節 研究架構..................................25
第三節 研究場所..................................27
第四節 研究對象..................................27
第五節 研究工具..................................28
第六節 研究步驟..................................32
第七節 研究倫理考量..............................34
第八節 研究資料處理及分析.........................34
第四章 研究結果..................................35
第一節 比較加護病房失智和沒有失智病人在前置因子和誘發因子上的差異..35
第二節 比較加護病房有無失智病人併發譫妄的發生率、型態、平均住院天數、醫療費用的差異
........................................42
第三節 比較加護病房病人發生譫妄在前置因子和誘發因子上的差異..44
第四節 加護病房病人譫妄的預測因子..................49
第五章 討論......................................54
第一節 加護病房病人研究變項於有無失智與譫妄之影響影..54
第二節 比較加護病房有無失智病人併發譫妄的發生率、型態、平均住院天數、醫療費用的差異
57
第三節 加護病房病人研究變項於譫妄之影響.............59
第四節 加護病房病人譫妄的預測因子...................60
第六章 研究結論與建議..............................62
第一節 研究結論...................................62
第二節 建議.......................................63
第三節 研究限制....................................63
參考文獻..........................................65
中文部分..........................................65
西文部分..........................................66
附錄..............................................76
附錄一 加護病房老人入住前失智與其發生譫妄之相關因素問卷調查..76
附錄二 評估紀錄單、檢驗報告及認知評估狀況............78
附錄三 老年人認知衰退問卷調查，簡稱（IQCODE）.......81
附錄四 簡易心智量表（Mini-Mental State Examination；MMSE)..83
附錄五 RASS鎮靜程度評估表(Richmond Agitation-Sedation Scale)..84
附錄六 中文版CAM-ICU Worksheet....................85
附錄七 內容效度專家名冊............................86
附錄八 老年人認知衰退問卷調查專家效度...............87
附錄九 老年人認知衰退問卷調查專家效度---建議修改後...89
表目次
表4- 1 MMSE分數(入院)與 IQCODE分數皮爾森相關........36
表4- 2 加護病房病人及有無失智病人人口學的基本屬性資料及相關因素..37
表4- 3 加護病房病人及有無失智病人疾病的基本屬性資料及相關因素..39
表4- 4 加護病房病人及有無失智病人藥物及外在刺激的基本屬性資料及相關因素..40
表4- 5 加護病房病人及有無失智病人之量表分數、住院天數、醫療費用之平均值描述及相關因
素.......................................42
表4- 6 加護病房有無失智病人發生譫妄型式、班別、持續時間、住院天數、醫療費用..44
表4- 7 加護病房譫妄病人人口學的基本屬性資料及相關因素.45
表4- 8 加護病房病人譫妄疾病的基本屬性資料及相關因素...47
表4- 9 加護病房譫妄病人之藥物及外在刺激的基本屬性資料及相關因素..48
表4- 10 加護病房病人譫妄基本屬性之平均值描述.........49
表4- 11 模式一、加護病房譫妄病人人口學相關因子之邏輯斯迴歸分析..50
表4- 12 模式二、加護病房譫妄病人人口學、病史相關因子之邏輯斯迴歸分析..51
表4- 13 模式三、加護病房譫妄病人人口學、病史、昏迷分數、疾病嚴重度及量表、約束、多
重管路相關因子之邏輯斯迴歸分析............53
圖目次
圖3- 1 研究架構...................................26
圖3- 2 研究步驟...................................33
圖4- 1 收案流程圖.................................36

中文部分
台灣臨床失智症學會(2016,01月16日)‧MMSE TDS 建議版‧取自http://www.tds.org.tw/ap/download_list.aspx?bid=49.
台灣失智症協會(2015,12月07日)‧認識失智症‧取自http://www.tada2002.org.tw/tada_know_02.html.
曹豪源、李宗霖、葉鉅全(2015)‧譫妄的評估及治療‧家庭醫學與基礎醫療，30(2)，41-48。
傅中玲(2008)‧台灣失智症現況‧台灣老年醫學暨老年學雜誌，3(3)，169-181。
楊鎮嘉、溫瓊容、詹鼎正(2014)‧老人譫妄症‧內科學誌，25，143-150。
陳美偵(2012)‧影響加護單位譫妄病人使用約束之相關因素與短期預後探討(未發表
的碩士論文)‧嘉義縣：長庚科技大學研究所。
楊濘綺(2011)‧唾液Cortisol濃度對加護單位患者發生譫妄的預測力(未發表的碩士論文)‧嘉義縣：長庚科技大學研究所。
劉建良、陳亮恭(2011)‧老年譫妄症‧台灣老誌，6(1)，1-14。
歐陽文貞(2013)‧DSM-5認知障礙症簡介‧DSM-5通訊，3(2)，13-20。

西文部分
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. doi: 10.1093/ageing/afu022. Epub 2014 Mar 6.
American Psychological Association (2015)‧DSM-5精神疾病診斷準則手冊(臺灣精神醫學會譯)‧台北市:合記。(原著出版於2013)
Anand, A., & MacLullich, A. M. J. (2013). Delirium in hospitalized older adults. Medicine, 41(1), 39-42.
Bail, K., Goss, J., Draper, B., Berry, H., Karmel, R., & Gibson, D. (2015). The cost of hospital-acquired complications for older people with and without dementia: A retrospective cohort study. BMC Health Services Research, 15, 1-9. doi: 10.1186/s12913-015-0743-1.
Balas, M. C., Deutschman, C. S., Sullivan-Marx, E. M., Strumpf, N. E., Alston, R. P., & Richmond, T. S. (2007). Delirium In Older Patients In Surgical Intensive Care Units. Journal of Nursing Scholarship, 39(2), 147-154.
Balas, M. C., Happ, M. B., Yang, W., Chelluri, L., & Richmond, T. (2009). Outcomes Associated With Delirium in Older Patients in Surgical ICUs. Chest, 135(1), 18-25. doi: 10.1378/chest.08-1456. Epub 2008 Nov 18.
Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., … Jaeschke, R. (2013). Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine, 41(1), 263-306. doi: 10.1097/CCM.0b013e3182783b72.
Bates, D., & Bates, C. (2013). Confusion and delirium. Medicine, 41:3.
Bergeron, N., Dubois, M. J., Dumont, M., Dial, S., & Skrobik, Y. (2001). Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Medicine, 27, 859–864. doi: 10.1007/s001340100909.
Boogaard, M. V. D., Schoonhoven, L., Achterberg, T. V., Hoeven, J. G. D., & Pickkers, P. (2013). Haloperidol prophylaxis in critically ill patients with a high risk for delirium. Critical Care, 17(1), 1-11. doi: 10.1186/cc11933.
Boogaard, M. V., Slooter, A. J. C., Kuiper, M. A., Spronk, P. E., Voort. V. D., Donders, R., & Achterberg, T. V. (2012). Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ, 344. doi: https://doi.org/10.1136/bmj.e420 (Published 09 February 2012).
Colombo, R., Corona, A., Praga, F., Minari, C., Giannotti, C., Castelli, A., & Raimondi, F. (2012). A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study. Minerva Anestesiol, 78(9), 1026-1033.
Davis, D. H., Barnes, L. E., Stephan, B. C., MacLullich, A. M., Meagher, D., Copeland, J., Matthews, F. E., & Brayne, C. (2014). The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS). BMC Geriatr, 14, 1-8. doi: 10.1186/1471-2318-14-87.
De, J., & Wand, A. P. (2015). Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients. Gerontologist, 55(6), 1079-1099. doi:10.1093/geront/gnv100. Epub 2015 Nov 5.
Deiner, S., Lin, H. M., Bodansky, D., Silverstein, J., & Sano, M. (2014). Do stress markers and anesthetic technique predict delirium in the elderly? . Dement Geriatr Cogn Disord, 38(5-6), 366-374. doi: 10.1159/000363762. Epub 2014 Aug 26.
Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R. (2016). Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology, 124(2), 362-368. doi: 10.1097/ALN.0000000000000951.
Donna, M. F., Melinda, R. Steis., Jennifer, L., Waller, Sharon, K., & Inouye, (2013). Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med, 8(9), 500–505. doi:10.1002/jhm.2077.
Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L.,…Dittus, R. (2001). Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Journal of the American Medical Association, 286(21), 2703-2710.
Ely, E. W., Truman, B., Shintani, A., Thomason, J. W., Wheeler, A. P., Gordon, S.,…Bernard, G. R. (2003). Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). The Journal of American association, 289(22), 2983-2991. doi: 10.1001/jama.289.22.2983.
Folstein, M., Folstein, S. E., & McHugh, P. (1975). Mini-mental state:a pactical method for grading the cognitive state:a practical method for grading the cognitive state if patient for the clinical. Journal of Psychiatric Research, 12(3), 189-198.
Fick, D. M., Steis, M. R., Waller, J. L., & Inouye, S. K., (2013). Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. Hospital Medicine, 19. doi:10.1002/jhm.2077.
Hart, R.P., Levenson, J. L., Sessler, C. N., Best, A. M., Schwartz, S. M., & Rutherford, L. E.(1996). Validation of a cognitive test for delirium in medical ICU patients, Psychosomatics, 37(6), 533-46. doi: 10.1016/S0033-3182(96)71517-7.
Hasemann, W., Tolson, D., Godwin, J., Spirig, R., Frei, I. A., & Kressig, R. W. (2016). A before and after study of a nurse led comprehensive delirium management programme (DemDel) for older acute care inpatients with cognitive impairment Clin Interv Aging. International Journal of Nursing Studies, 53, 27-38. doi: 10.1016/j.ijnurstu.2015.08.003. Epub 2015 Aug 17.
Hatta, K., Kishi, Y., Wada, K., Takeuchi, T., Odawara, T., Usui, C., & Nakamura, H. (2014). Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry, 71(4), 397-403. doi: 10.1001/jamapsychiatry.2013.3320.
Heaven, A., Cheater, F., Clegg, A., Collinson, M., Farrin, A., Forster, A., Godfrey, M., Graham, L., Grice, A., Holt, R., Hulme, C., Lloyd, E., Meads, D., North, C., Young, J., & Siddiqi, N. (2014). Pilot trial of Stop Delirium! (PiTStop)--a complex intervention to prevent delirium in care homes for older people: study protocol for a cluster randomised controlled trial. Trials, 15,1-2. doi: 10.1186/1745-6215-15-47.
Holly, C., Cantwell, E. R., & Jadotte, Y. (2012). Acute delirium: Differentiation and care. Crit Care Nurs Clin North Am. 24, 131-147. doi: 10.1016/j.ccell. 2012.01.008.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A., Martin, R. L. (1982). A new clinical scale for the staging of dementia, Br J Psychiatry, 140, 566-572.
Inouye, S. K.,(1999). Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord, 10(5), 393-400. doi: 17177.
Inouye, S. K., Westendorp, R. G. J., & Saczynski, J. S. (2013). Delirium in elderly people. The Lancet. Retrieved from http://www.thelancet.com.
Knaus, W. A., Draper, E. A., Wagner, D. P., Zimmerman, J. E. (1985). APACHE II: a
severity of disease classification system. Critical Care Med, 13(10), 818-829.
Karuza, J., Katz, P.R., & Henderson, R., Andersen, E., Rothenberg, B. & Zimmer, J. G. (1997). Cognitive screening In Assessing the health status of order adults, 218-289. New York:Springer.
Kennedy, M., Enander, R. A., Tadiri, S. P., Wolfe, R. E., Shapiro, N. I., & Marcantonio, E. R. (2014). Delirium risk prediction, healthcare use and mortality of elderly adults in the emergency department. J Am Geriatr Soc, 62(3), 462-9. doi: 10.1111/jgs.12692. Epub 2014 Feb 10.
Kolanowski, A., Mulhall, P., Yevchak, A., Hill, N., & Fick, D. (2013). The triple challenge of recruiting older adults with dementia and high medical acuity in skilled nursing facilities. J Nurs Scholarsh, 45(4), 397-404.
Kolanowski,A., Mogle, J., Fick, DM., Campbell, N., Hill, N., Mulhall, P., Behrens, L., Colancecco, E., Boustani, M., & Clare, L. (2015). Anticholinergic Exposure During Rehabilitation: Cognitive and Physical Function Outcomes in Patients with Delirium Superimposed on Dementia. Am J Geriatr Psychiatry, 23(12), 1250-1258. doi: 10.1016/j.jagp.2015.07.004. Epub 2015 Jul 31.
Kolanowski, A., Mogle, J., Fick, D. M., Hill, N., Mulhall, P., Nadler, J., Colancecco, E., & Behrens, L. (2015). Pain, delirium, and physical function in skilled nursing home patients with dementia. J Am Med Dir Assoc, 16(1), 37-40. doi: 10.1016/j.jamda.2014.07.002. Epub 2014 Sep 18.
Kuczmarska, A., Guess, J., O'Connor, M. A., Branford-White, L., Palihnich, K., Gallagher, J., & Marcantonio, E. R. (2015). Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU. J Gen Intern Med, 31(3), 297-303. doi: 10.1007/s11606-015-3514-0.
Leonard, M., McInerney, S., McFarland1, J., Condon, Candice., Awan1, Fahad, O'Connor, M., Reynolds, P., Meaney, A. M., Adamis, D., Dunne, C., Cullen, W., Trzepacz, P. T., & Meagher, D. J. (2016). Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia. BMJ Open, 6.
Lorenzo, M., Aldecoa, C., Rico, J. (2013). Delirium in the critically ill patient. Trends in Anaesthesia and Critical Care, 3, 257-264. doi: http://dx.doi.org/ 10.1016/j.tacc.2013.05.00.
Lütz, A., Radtke, F. M., Franck, M., Seeling, M., Gaudreau, J. D., Kleinwächter, R, Kork, F., Zieb, A., Heymann, A., Spies, C.D (2008), The Nursing Delirium Screening Scale (NU-DESC). Anästhesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 43(2),98-102. doi: 10.1055/s-2008-1060551
Margaret, A., Pisani, Terrence, E., Murphy, Peter, H., Van, Ness., Katy, L. B., Araujo, Sharon, K., Inouye, M. D., (2012). Characteristics Associated With Deliriumin Older
Patients in a Medical Intensive Care Unit. Arch Intern Med, 167(15), 1629-1634. doi:10.1001/archinte.167.15.1629.
Margaret, A., Pisani, So, Y. J. K., Stanislav, V. K., Terrence, E. M., Katy, L. B. A., & Peter, H. V. N. (2009). Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population. Am J Respir Crit Care Med, 18, 1092-1097.
McNicoll, L., Pisani, M. A., Zhang, Y., Ely, E. W., Siegel,M.D., & Inouye,S.K. (2003). Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients. Clinical Investigations, 51(5), 591-598.
Morandi, A., McCurley, J., Vasilevskis, E. E., Fick, D. M., Bellelli, G., Lee, P., Jackson, J. C., Shenkin, S.D., Marcotrabucchi, Schnelle , J., Inouye, S. K., Ely, E. W., & MacLullich, A. (2012). Tools to detect delirium superimposed on dementia: a systematic review. J Am Geriatr Soc, 60(11), 2005-2013. doi: 10.1111/j.1532-5415.2012.04199.x. Epub 2012 Oct 5.
McCrow, J., Sullivan, K. A., & Beattie, E. R.(2014). Delirium knowledge and recognition: a randomized controlled trial of a web-based educational intervention for acute care nurses. Nurse Education Today, 34(6), 912-917. doi: 10.1016/j.nedt.2013.12.006. Epub 2013 Dec 22.
Neelon, V. J., Champagne, M. T., Carlson, J. R., & Funk, S. G. (1996). The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nursing research, 45(6), 324-330.
O’Regan, N. A., Fitzgerald, J., Timmons, S., O’Connell, H., & Meagher, D. (2013). Delirium: A key challenge for perioperative care. International Journal of Surgery, 11, 136-144.
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of American Geriatrics Society. 23, 433-41.
Pisani, M. A., Kong, S. Y. J., Kasl, S. V., Murphy, T. E., Araujo, K. L. B., & Ness, P. H. V. (2009). Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population. American Journal of Respiratory and Critical Care Medicine, 180, 1092-1097.
Pisani, M. A., Murphy, T. E., Van Ness, P. H., Araujo, K. L. B., & Inouye, S. K. (2007). Characteristics Associated With Delirium in Older Patients in a Medical Intensive Care Unit . Archives of Internal Medicine, 167(15), 1629-1634.
Paddick, S. M., Kalaria, R.N., & Mukaetova-Ladinska, E. B. (2015). The prevalence and clinical manifestations of delirium in sub-Saharan Africa: a systematic review with inferences. Journal of the Neurological Sciences, 348(1-2), 6-17. doi: 10.1016/j.jns.2014.10.034. Epub 2014 Nov 8.
Regal, P. J. (2015). A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study.Clinical Interventions in Aging, 13(10), 473-480. doi: 10.2147/CIA.S78206. eCollection 2015.
Rivosecchi, R. M., Kane-Gill, S. L., Svec, S., Campbell, S., & Smithburger, P. L. (2016). The implementation of a nonpharmacologic protocol to prevent intensive care delirium. Journal of Critical Care, 31(1), 206-211. doi: 10.1016/j.jcrc.2015.09.031. Epub 2015 Oct 17.
Quinn, T. J., Fearon, P., Noel-Storr, A. H., Young, C., McShane, R., & Stott, D. J. (2014). Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within community dwelling populations. Cochrane Database Syst Rev, (4), 2. doi: 10.1002/14651858.CD010079.pub2.
Rundshagen, I. (2015). Postoperative cognitive dysfunction. Deutsches Arzteblatt International, 111(8), 119-125. doi:10.3238/arztebl.2014.0119
Sarutzki-Tucker, A., & Ferry, R. (2014). Beware of delirium. The Journal for Nurse Practitioners, 10(8), 575-581. doi: http://dx.doi.org/10.1016/j.nurpra. 2014. 07.003.
Sands, M. B., Dantoc, B. P., Hartshorn, A., Ryan, C. J., & Lujic, S. (2010). Single question in delirium (SQiD): testing its efficacy against psychiatrist interview, the confusion assessment method and the memorial delirium assessment scale. Palliative Medicine, 24(6), 561-565.
Sheehan, B. (2012). Assessment scales in dementia. Therapeutic Advances in Neurological Disorders,5(6), 349-358. doi: 10.1177/1756285612455733.
The American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. (2015). Postoperative delirium in older adults: Best practice statement from the American Geriatrics Society. The American College of Surgeons, 220(2), 136-148. doi:http://dx.doi.org/10.1016/j.jamcollsurg.2014. 10.019.
Tanajewski, L., Franklin, M., Gkountouras, G., Berdunov, V., Harwood, R. H., Goldberg, S. E., Bradshaw, L. E., Gladman, J. R. F., & Elliott, R. A. (2015). Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial). Published online,18, 1-20. doi:10.1371/journal.pone.0140662.
Travers, C., Byrne, G., Pachana, N., Klein. K., & Gray, L. (2013). Prospective observational study of dementia and delirium in the acute hospital setting. Internal Medicine Journal, 43(3), 262-9. doi:10.1111/j.1445-5994.2012.02962.x.
Volland, J., Fisher, A., & Drexler, D. (2015). Delirium and Dementia in the Intensive Care Unit: Increasing Awareness for Decreasing Risk, Improving Outcomes, and Family Engagement. Dimensions of Critical Care Nursing, 34(5), 259-264. doi: 10.1097/DCC.0000000000000133.
Vasilevskis, E. E., Han. J, H., Hughes, C. G., & Ely, E. W. (2012). Epidemiology and risk factors for delirium across hospital settings. Best Practice & Research Clinical Anaesthesiology, 26, 277-287.
Wesselink, E.M., Kappen, T. H., Klei, W. A. V., J. Dieleman, J. M., Dijk, D. V., & Slooter, A. J. C. (2015). Intraoperative hypotension and delirium after on-pump cardiac surgery. British Journal of Anaesthesi, 115(3), 427–433. doi: 10.1093/bja/aev256.
Yang Y. H., Galvin, J. E., Morris, J. C., Lai, C. L., Chou, M. C., Liu, C. K. (2011). Application of AD8 questionnaire to screen very mild dementia in Taiwanese. Am J Alzheimers Dis Other Demen,26(2),134-8.
Yevchak, A. M., Fick, D. M., McDowell, J., Monroe, T., May, K., Grove, L., Kolanowski, A. M., Waller, J. L., & Inouye, S. K. (2014). Barriers and facilitators to implementing delirium rounds in a clinical trial across three diverse hospital settings. Clin Nurs Res, 23(2), 201–215. doi: 10.1177/1054773813505321. Epub 2013 Oct 11.
Yilmaz, S., Aksoy, E., Diken, A.I., Yalcinkaya, A., Erol, M. E., & Cagli, K. (2016). Dopamine Administration is a Risk Factor for Delirium in Patients Undergoing Coronary Artery Bypass Surgery. Heart, Lung and Circulation, 25(5), 493-498. doi: 10.1016/j.hlc.2015.09.012. Epub 2015 Oct 22.
Zaal, I. J., Devlin, J. W., Peelen, L. M., & Slooter, A.J. (2015). A systematic review of risk factors for delirium in the ICU. Critical Care Medicine, 43(1), 40-47. doi: 10.1097/CCM.0000000000000625.
Zeng , L., Josephson, S. A., Fukuda, K. A., Neuhaus, J., & Douglas, V.C. (2015). A Prospective Comparison of Informant-based and Performance-based Dementia Screening Tools to Predict In-Hospital Delirium. Alzheimer Dis Assoc Disord, 29(4), 312-316. doi: 10.1097/WAD.0000000000000066.