- Email: [email protected]
P016: Use of physical restraints in a general hospital
Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
Method: Retrospective study of journals from patients admitted to the geriatric ward in Roskilde/Koege Hospital in the period from 01.11.2009 to 31.10.2013 where PET-CT was performed. Inclusion criteria were: CRP >8mg/L, or Leukocytes >8.8×109 /L, or fever 37.8°C and clinical symptoms, where the initial investigation (II) was inconclusive. The II included blood samples, microbiology, X-rays, ultrasound or CT as indicated. Clinical symptoms were: Relapse of infection, lack of sufficient response to antibiotic treatment, weight loss, fatigue or loss of activities of daily living (ADL) functions. Results: A total of 19 patients were included in the study. The PET-CT diagnosed 6 patients with localized infection. Seven patients had findings consistent with cancer. One patient had both cancer and infection. Three patients had thromboembolism. One patient had both thromboembolism and cancer. One patient had both thromboembolism and infection. PET-CT did not explain the symptoms in 6 patients (Table 1). Conclusion: The results indicate that PET-CT might be a valuable procedure in the investigation of patients with clinical symptoms and signs of inflammation in blood samples. It might help diagnose insufficient treated infections, inflammations and cancer in situations where II is negative. Further examination of PET-CT use carried out in a prospective multi-center setup is needed to confirm the findings from this study. P013 Are we missing hypoglycaemia in elderly people? S.V. Hope1 , P.J. Taylor2 , B.M. Shields3 , R.A. Oram3 , A.J. Chakera3 , A.T. Hattersley3 1 NHS, Exeter, United Kingdom; 2 Axminster Medical Practice, Axminster, United Kingdom; 3 Exeter NIHR Clinical Research Facility, University of Exeter, Exeter, United Kingdom Introduction: Hypoglycaemia is a potentially fatal side-effect of diabetes treatment. Its recognition is difficult in older patients: as with many clinical presentations in this group, the symptoms are non-specific. We explored if these non-specific symptoms can be discriminatory for hypoglycaemia. Methods: Data were collected from a GP-database on people aged >65 with and without diabetes. Frequency of hypoglycaemia and consultations for “hypo-clues” were recorded (eg unexplained dizziness, confusion, sweating) between 5/2/12–4/2/13. Results: 334 records were reviewed (79 patients on insulin, 85 on sulphonylureas, 120 on metformin only, 50 without diabetes). Patients with >1 recognised hypoglycaemic event were twice as likely to attend with a “hypo-clue” on another occasion, compared to those without a documented hypoglycaemic event: 1.91 vs 0.92 “hypo-clue” visits/patient/year, p = 0.002. Patients on insulin were more likely to consult with a “hypoclue” – 1.61 consultations/patient/year (p = 0.03), sulphonylureatreated patients 0.98, metformin only-treated patients 0.99, and non-diabetic patients 0.76. Insulin-treated patients also had more recognised hypoglycaemia: 1.1 episodes/patient/year, versus 0.21 if on sulphonylureas, 0.07 on metformin, and none without diabetes, p < 0.001. In patients with diabetes, both the frequency of hypos and “hypoclue” consultations was increased with the number of comorbidities (beta regression coefficient = 0.14 hypos/comorbidity (95% CI 0.05– 0.23; p = 0.001); 0.47 “hypo-clue” consultations/comorbidity (95% CI 0.31–0.63; p < 0.001)); this was not the case in patients without diabetes. Conclusions: “Hypo-clues” are associated with recognised hypoglycaemia and insulin treatment, suggesting some of these consultations may represent unrecognised hypoglycaemia. This is clinically important as these symptoms in high risk patients should alert clinicians to actively considering hypoglycaemia and the need to review treatment.
S87
Delirium P015 Ertapenem induced visual hallucinations C. Michael, T. Witharanage Russells Hall Hospital, Dudley, United Kingdom Case report: A 96-year-old patient was treated for ESBL producing Klebsiella pneumoniae urinary tract infection with Ertapenem. However she started to be confused. According to the daughter, her mother was ‘as sharp as a tack’. First day of antibiotic was uneventful. After the second dose she became confused and had visual hallucinations (e.g. seeing people inside the house, eating non-existent food from her plate). After each dose her confusion became worse. Ertapenem was continued for 6 doses, assuming that the symptoms were due to the infection. It was noticed that twenty minutes after the injection she experienced a hallucination of ‘A man eating spiders’. Ertapenem was stopped after the 6th dose (on the 7th day). Urine culture was negative and CT showed only age related cerebral atrophy. By evening confusion was slightly improving. On microbiology advice Ertapenem was restarted again on the 8th day and following the dose the patient became extremely confused and was hallucinating so Ertapenem was stopped. After stopping of Ertapenem she came back to her normal cognitive level. She remembered seeing things and being muddled. Discussion: Visual hallucination is a false sense perception. It could be a manifestation of poor vision (Charles Bonnet syndrome), dementia especially Lewy body dementia, psychiatric disorder or a side effect of medications. The most common medications that can cause visual hallucinations include: L dopa, dopamine agonists, COMT inhibitors, MAOB inhibitors, anticholinergic medications, benzodiazepines, narcotic analgesics, dextromethorphan, steroids, amphetamines and “club drugs”. In our case the hallucinations were a side effect of Ertapenem. It started with the introduction of the antibiotic, improved when it was omitted, restarted after it was reinstated and disappeared after it was stopped. Reviewing the literature there were rare case reports of similar cases. Kong and Beckert et al reported a 58 years old male who developed visual hallucinations after receiving Ertapenem (1). Wen MJ and Sung CC et al reported hallucinations in 2 patients with Chronic Kidney Disease (CKD) stages 4 and 5, despite following the required dose reductions for the use of Ertapenem in CKD (2). These CNS affects may be due to Ertapnem’s Lipophilicity and the ability to cross the blood brain barrier. Reference(s) [1] Kong V, Beckert L, Awunor-Renner A. A case of beta lactam-induced visual hallucination. NZMJ 02/2009; 122(1298): 76–7. [2] Wen MJ, Sung CC, Chau T, Lin SH. Acute prolonged neurotoxicity associated with recommended doses of ertapenem in 2 patients with advanced renal failure. Clin Nephrol. 2013 Dec; 80(6): 474–8.
P016 Use of physical restraints in a general hospital E. Gil1 , B. Raguan2 , E. Wolfovitz1 1 Bnai Zion Medical Center, Haifa, Israel; 2 Technion, Faculty of Medicine, Haifa, Israel Introduction: Physical restraints are a common, albeit controversial, tool in the acute care setting. Our study aimed to (1) determine the prevalence of physical restraint use in an acute-care hospital, (2) find out whether physical restraints are used more commonly in night shifts, (3) identify
S88
Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
patient risk factors for physical restraint use, (4) establish if staffto-patient ratio correlated with physical restraint use. Methods: A prospective, observational and case-control study was conducted over 3 months in 2013, in medical, surgical and intensive care units in a mid-sized general hospital. All the physically restrained patients in each observation were added to the registry. Each ward was reviewed once for casecontrols, with all non-restrained patients added. The prevalence of physical restraints (excluding bed-rails) was measured, and data on patients in the study registry were collected. Results: 2,163 patients were included. 76 were restrained, and 205 included as case-controls. The prevalence of physical restraint use was 3.51% (95% CI = [2.79%, 4.37%]). Physical restraint use was more common in night shifts than day shifts: 4.40% vs. 2.56% (p-value = 0.03). Male gender, dependency, invasive ventilation, invasive tubes (NG tube or urine catheter), and bedsores were all significantly correlated to restraint use. Staff-to-patient ratios were not significantly correlated with physical restraint use. Conclusion: Physical restraints are relatively common in acute care wards. The use of physical restraints seems to be correlated with certain patient characteristics, but not staff-to-patient ratios, and to be more common at night. P017 The phenomenology of delirium in elderly outpatients: a case-control study A.J. Stroomer-van Wijk1 , H.J. Luijendijk2 Parnassia Bavo Groep, Leiden, The Netherlands; 2 Universitair Medisch Centrum Groningen, Groningen, The Netherlands
1
Introduction: Delirium can be difficult to recognize, especially in patients with pre-morbid dementia. Most dementia patients live at home. Studies about the phenomenology of delirium in outpatients are lacking. The aim of this study was to describe the symptoms and somatic aetiology of delirium in elderly outpatients. Methods: We performed a case-control study among 275 elderly outpatients who were referred for cognitive screening to a centre for old age psychiatry. Between January and July 2010, 44 cases of delirium were diagnosed (16%). Twenty-four of these patients had pre-morbid dementia. Another 44 patients with dementia only were the controls. Data were collected from the medical files. Symptoms and severity of delirium were scored with DRS-98R. Precipitating and contributing factors were recorded. Results: On average, delirium had started 3.7 weeks (range 0.2–12) before referral. Symptoms that occurred significantly more often in patients with delirium compared to dementia only were: sleep-wake cycle disturbances (89% vs 18%), affect lability (86% vs 32%), thought process abnormalities (84% vs 59%), misperceptions (71% vs 11%), motor agitation (50% vs 5%), and inattention (100% vs 62%). Memory deficits and disorientation occurred frequently in both groups. Acute onset, fluctuations in severity, and presence of a contributing physical disorder significantly distinguished delirium with or without dementia from dementia only. Common precipitating or contributing factors were medication (68%), infection (59%), metabolic disturbance (45%) and dehydration (26%). Conclusions: The clinical profile of patients with delirium showed substantial differences compared to patients with dementia only. Sleep-wake cycle disturbance was the most distinguishing feature.
P018 Impact of Gineste-Marescotti method (GMM) in acute confusion outcomes (research protocol) H.L. Neves1 , J. Sousa1 , C.J.S. Oliveira2 , H. Jose´ 3 1 The Catholic University of Portugal, Portugal; 2 ICS-UCP, Lisboa, Portugal; 3 Multiperfil, Luanda, Angola, Portugal Introduction: With life expectancy increase, with consequent admission of more aged patients, Acute Confusion (AC), is an undeniable reality in every health institution. Management of such phenomenon is extremely hard, and require full awareness by the nurse to prevent negative outcomes in these patients. As a complex intervention, composed of 150 nursing techniques, the GinesteMarescotti method (GMM) has been shown to improve cognitive capacities in the elders, reducing agitation and use of chemical restraints. Methods: A quasi-experimental study will be developed in two neurological wards (experimental ward vs standard care ward). Inclusion criteria are patients at risk or with low to moderate confusion (obtained through application of the NEECHAM Scale). Data will be collected for change in AC status, use of pharmacological and physical restraints, agitation, falls, mortality rates, length of stay (LoS), and place of stay after hospital discharge. Results: It is expected that the method will prevent development of acute confusion in patients at risk, as well as prevent worsening of mental state in patients with low to moderate AC. This will impact the use of pharmacological and physical restraints, reduce agitation episodes, decrease mortality rates associated with complication due to AC, and with mental status maintained or improved, LoS may decrease, less patients will be discharged for nursing homes and more patients will be discharged to their families. Conclusion: The aim of this study is to access cost-effectiveness of the GMM regarding Acute Confusion outcomes, and also to add evidence to the importance GMM in nursing practice. P019 Delirium in elderly general medical inpatients: a hospital-based study M. Foroughan1 , S. Ebn Saeed2 , A.A. Akbari Kamrani1 , A. Delbari1 University of Social Welfare and ehabilitation Sciences, Tehran, Iran; 2 Naft Hospital, Ahvaz, Iran
1
Introduction: The aims of this study were to investigate the occurrence of delirium and its risk factors in a sample of hospitalized elderly in the Southwest of Iran. Methods: A cross-sectional study was performed on a total of 200 elderly patients over 60 years successively presented to a general hospital located in the city of Ahvaz, Iran, during a threemonth period in 2010. Data regarding Physical, cognitive, emotional and functional states of the participants were gathered using history, physical exam and para-clinical exams and implementing Informant Questionnaire for the Cognitive Decline in the Elderly (IQCODE), Geriatric Depression Scale (GDS), and Activities of Daily Living (ADL), respectively. Delirium development screened using Abbreviated Mental Test Score (AMTS) in post-admission days 1, 3, and 5 and diagnosed according to DSM-IV-TR Criteria for delirium. Results: Delirium developed in 22% of the elderly patients admitted to the hospital. Delirious patients were typically older (78.5±8.2 vs. 70.7±6, P = 0.001), men (42.4% for men and 11.9% for women, P = 0.001), with low level of education (P = 0.001), single (P = 0.001), lived alone (P = 0.001), and had poorer functional status (P = 0.022). the followings were significantly associated with delirium: abnormal hemoglobin levels (P = 0.000), higher ESR levels (P = 0.000), abnormal BUN/creatinine ratios (P = 0.005), and positive CRP (p = 0.022). polypharmacy as a risk factor was found the most potent for delirium {63.6 of all patients with delirium [odds ratio (OR) 2.15], P = 0.028}. Mean IQCODE score were significantly higher
Method: Retrospective study of journals from patients admitted to the geriatric ward in Roskilde/Koege Hospital in the period from 01.11.2009 to 31.10.2013 where PET-CT was performed. Inclusion criteria were: CRP >8mg/L, or Leukocytes >8.8×109 /L, or fever 37.8°C and clinical symptoms, where the initial investigation (II) was inconclusive. The II included blood samples, microbiology, X-rays, ultrasound or CT as indicated. Clinical symptoms were: Relapse of infection, lack of sufficient response to antibiotic treatment, weight loss, fatigue or loss of activities of daily living (ADL) functions. Results: A total of 19 patients were included in the study. The PET-CT diagnosed 6 patients with localized infection. Seven patients had findings consistent with cancer. One patient had both cancer and infection. Three patients had thromboembolism. One patient had both thromboembolism and cancer. One patient had both thromboembolism and infection. PET-CT did not explain the symptoms in 6 patients (Table 1). Conclusion: The results indicate that PET-CT might be a valuable procedure in the investigation of patients with clinical symptoms and signs of inflammation in blood samples. It might help diagnose insufficient treated infections, inflammations and cancer in situations where II is negative. Further examination of PET-CT use carried out in a prospective multi-center setup is needed to confirm the findings from this study. P013 Are we missing hypoglycaemia in elderly people? S.V. Hope1 , P.J. Taylor2 , B.M. Shields3 , R.A. Oram3 , A.J. Chakera3 , A.T. Hattersley3 1 NHS, Exeter, United Kingdom; 2 Axminster Medical Practice, Axminster, United Kingdom; 3 Exeter NIHR Clinical Research Facility, University of Exeter, Exeter, United Kingdom Introduction: Hypoglycaemia is a potentially fatal side-effect of diabetes treatment. Its recognition is difficult in older patients: as with many clinical presentations in this group, the symptoms are non-specific. We explored if these non-specific symptoms can be discriminatory for hypoglycaemia. Methods: Data were collected from a GP-database on people aged >65 with and without diabetes. Frequency of hypoglycaemia and consultations for “hypo-clues” were recorded (eg unexplained dizziness, confusion, sweating) between 5/2/12–4/2/13. Results: 334 records were reviewed (79 patients on insulin, 85 on sulphonylureas, 120 on metformin only, 50 without diabetes). Patients with >1 recognised hypoglycaemic event were twice as likely to attend with a “hypo-clue” on another occasion, compared to those without a documented hypoglycaemic event: 1.91 vs 0.92 “hypo-clue” visits/patient/year, p = 0.002. Patients on insulin were more likely to consult with a “hypoclue” – 1.61 consultations/patient/year (p = 0.03), sulphonylureatreated patients 0.98, metformin only-treated patients 0.99, and non-diabetic patients 0.76. Insulin-treated patients also had more recognised hypoglycaemia: 1.1 episodes/patient/year, versus 0.21 if on sulphonylureas, 0.07 on metformin, and none without diabetes, p < 0.001. In patients with diabetes, both the frequency of hypos and “hypoclue” consultations was increased with the number of comorbidities (beta regression coefficient = 0.14 hypos/comorbidity (95% CI 0.05– 0.23; p = 0.001); 0.47 “hypo-clue” consultations/comorbidity (95% CI 0.31–0.63; p < 0.001)); this was not the case in patients without diabetes. Conclusions: “Hypo-clues” are associated with recognised hypoglycaemia and insulin treatment, suggesting some of these consultations may represent unrecognised hypoglycaemia. This is clinically important as these symptoms in high risk patients should alert clinicians to actively considering hypoglycaemia and the need to review treatment.
S87
Delirium P015 Ertapenem induced visual hallucinations C. Michael, T. Witharanage Russells Hall Hospital, Dudley, United Kingdom Case report: A 96-year-old patient was treated for ESBL producing Klebsiella pneumoniae urinary tract infection with Ertapenem. However she started to be confused. According to the daughter, her mother was ‘as sharp as a tack’. First day of antibiotic was uneventful. After the second dose she became confused and had visual hallucinations (e.g. seeing people inside the house, eating non-existent food from her plate). After each dose her confusion became worse. Ertapenem was continued for 6 doses, assuming that the symptoms were due to the infection. It was noticed that twenty minutes after the injection she experienced a hallucination of ‘A man eating spiders’. Ertapenem was stopped after the 6th dose (on the 7th day). Urine culture was negative and CT showed only age related cerebral atrophy. By evening confusion was slightly improving. On microbiology advice Ertapenem was restarted again on the 8th day and following the dose the patient became extremely confused and was hallucinating so Ertapenem was stopped. After stopping of Ertapenem she came back to her normal cognitive level. She remembered seeing things and being muddled. Discussion: Visual hallucination is a false sense perception. It could be a manifestation of poor vision (Charles Bonnet syndrome), dementia especially Lewy body dementia, psychiatric disorder or a side effect of medications. The most common medications that can cause visual hallucinations include: L dopa, dopamine agonists, COMT inhibitors, MAOB inhibitors, anticholinergic medications, benzodiazepines, narcotic analgesics, dextromethorphan, steroids, amphetamines and “club drugs”. In our case the hallucinations were a side effect of Ertapenem. It started with the introduction of the antibiotic, improved when it was omitted, restarted after it was reinstated and disappeared after it was stopped. Reviewing the literature there were rare case reports of similar cases. Kong and Beckert et al reported a 58 years old male who developed visual hallucinations after receiving Ertapenem (1). Wen MJ and Sung CC et al reported hallucinations in 2 patients with Chronic Kidney Disease (CKD) stages 4 and 5, despite following the required dose reductions for the use of Ertapenem in CKD (2). These CNS affects may be due to Ertapnem’s Lipophilicity and the ability to cross the blood brain barrier. Reference(s) [1] Kong V, Beckert L, Awunor-Renner A. A case of beta lactam-induced visual hallucination. NZMJ 02/2009; 122(1298): 76–7. [2] Wen MJ, Sung CC, Chau T, Lin SH. Acute prolonged neurotoxicity associated with recommended doses of ertapenem in 2 patients with advanced renal failure. Clin Nephrol. 2013 Dec; 80(6): 474–8.
P016 Use of physical restraints in a general hospital E. Gil1 , B. Raguan2 , E. Wolfovitz1 1 Bnai Zion Medical Center, Haifa, Israel; 2 Technion, Faculty of Medicine, Haifa, Israel Introduction: Physical restraints are a common, albeit controversial, tool in the acute care setting. Our study aimed to (1) determine the prevalence of physical restraint use in an acute-care hospital, (2) find out whether physical restraints are used more commonly in night shifts, (3) identify
S88
Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
patient risk factors for physical restraint use, (4) establish if staffto-patient ratio correlated with physical restraint use. Methods: A prospective, observational and case-control study was conducted over 3 months in 2013, in medical, surgical and intensive care units in a mid-sized general hospital. All the physically restrained patients in each observation were added to the registry. Each ward was reviewed once for casecontrols, with all non-restrained patients added. The prevalence of physical restraints (excluding bed-rails) was measured, and data on patients in the study registry were collected. Results: 2,163 patients were included. 76 were restrained, and 205 included as case-controls. The prevalence of physical restraint use was 3.51% (95% CI = [2.79%, 4.37%]). Physical restraint use was more common in night shifts than day shifts: 4.40% vs. 2.56% (p-value = 0.03). Male gender, dependency, invasive ventilation, invasive tubes (NG tube or urine catheter), and bedsores were all significantly correlated to restraint use. Staff-to-patient ratios were not significantly correlated with physical restraint use. Conclusion: Physical restraints are relatively common in acute care wards. The use of physical restraints seems to be correlated with certain patient characteristics, but not staff-to-patient ratios, and to be more common at night. P017 The phenomenology of delirium in elderly outpatients: a case-control study A.J. Stroomer-van Wijk1 , H.J. Luijendijk2 Parnassia Bavo Groep, Leiden, The Netherlands; 2 Universitair Medisch Centrum Groningen, Groningen, The Netherlands
1
Introduction: Delirium can be difficult to recognize, especially in patients with pre-morbid dementia. Most dementia patients live at home. Studies about the phenomenology of delirium in outpatients are lacking. The aim of this study was to describe the symptoms and somatic aetiology of delirium in elderly outpatients. Methods: We performed a case-control study among 275 elderly outpatients who were referred for cognitive screening to a centre for old age psychiatry. Between January and July 2010, 44 cases of delirium were diagnosed (16%). Twenty-four of these patients had pre-morbid dementia. Another 44 patients with dementia only were the controls. Data were collected from the medical files. Symptoms and severity of delirium were scored with DRS-98R. Precipitating and contributing factors were recorded. Results: On average, delirium had started 3.7 weeks (range 0.2–12) before referral. Symptoms that occurred significantly more often in patients with delirium compared to dementia only were: sleep-wake cycle disturbances (89% vs 18%), affect lability (86% vs 32%), thought process abnormalities (84% vs 59%), misperceptions (71% vs 11%), motor agitation (50% vs 5%), and inattention (100% vs 62%). Memory deficits and disorientation occurred frequently in both groups. Acute onset, fluctuations in severity, and presence of a contributing physical disorder significantly distinguished delirium with or without dementia from dementia only. Common precipitating or contributing factors were medication (68%), infection (59%), metabolic disturbance (45%) and dehydration (26%). Conclusions: The clinical profile of patients with delirium showed substantial differences compared to patients with dementia only. Sleep-wake cycle disturbance was the most distinguishing feature.
P018 Impact of Gineste-Marescotti method (GMM) in acute confusion outcomes (research protocol) H.L. Neves1 , J. Sousa1 , C.J.S. Oliveira2 , H. Jose´ 3 1 The Catholic University of Portugal, Portugal; 2 ICS-UCP, Lisboa, Portugal; 3 Multiperfil, Luanda, Angola, Portugal Introduction: With life expectancy increase, with consequent admission of more aged patients, Acute Confusion (AC), is an undeniable reality in every health institution. Management of such phenomenon is extremely hard, and require full awareness by the nurse to prevent negative outcomes in these patients. As a complex intervention, composed of 150 nursing techniques, the GinesteMarescotti method (GMM) has been shown to improve cognitive capacities in the elders, reducing agitation and use of chemical restraints. Methods: A quasi-experimental study will be developed in two neurological wards (experimental ward vs standard care ward). Inclusion criteria are patients at risk or with low to moderate confusion (obtained through application of the NEECHAM Scale). Data will be collected for change in AC status, use of pharmacological and physical restraints, agitation, falls, mortality rates, length of stay (LoS), and place of stay after hospital discharge. Results: It is expected that the method will prevent development of acute confusion in patients at risk, as well as prevent worsening of mental state in patients with low to moderate AC. This will impact the use of pharmacological and physical restraints, reduce agitation episodes, decrease mortality rates associated with complication due to AC, and with mental status maintained or improved, LoS may decrease, less patients will be discharged for nursing homes and more patients will be discharged to their families. Conclusion: The aim of this study is to access cost-effectiveness of the GMM regarding Acute Confusion outcomes, and also to add evidence to the importance GMM in nursing practice. P019 Delirium in elderly general medical inpatients: a hospital-based study M. Foroughan1 , S. Ebn Saeed2 , A.A. Akbari Kamrani1 , A. Delbari1 University of Social Welfare and ehabilitation Sciences, Tehran, Iran; 2 Naft Hospital, Ahvaz, Iran
1
Introduction: The aims of this study were to investigate the occurrence of delirium and its risk factors in a sample of hospitalized elderly in the Southwest of Iran. Methods: A cross-sectional study was performed on a total of 200 elderly patients over 60 years successively presented to a general hospital located in the city of Ahvaz, Iran, during a threemonth period in 2010. Data regarding Physical, cognitive, emotional and functional states of the participants were gathered using history, physical exam and para-clinical exams and implementing Informant Questionnaire for the Cognitive Decline in the Elderly (IQCODE), Geriatric Depression Scale (GDS), and Activities of Daily Living (ADL), respectively. Delirium development screened using Abbreviated Mental Test Score (AMTS) in post-admission days 1, 3, and 5 and diagnosed according to DSM-IV-TR Criteria for delirium. Results: Delirium developed in 22% of the elderly patients admitted to the hospital. Delirious patients were typically older (78.5±8.2 vs. 70.7±6, P = 0.001), men (42.4% for men and 11.9% for women, P = 0.001), with low level of education (P = 0.001), single (P = 0.001), lived alone (P = 0.001), and had poorer functional status (P = 0.022). the followings were significantly associated with delirium: abnormal hemoglobin levels (P = 0.000), higher ESR levels (P = 0.000), abnormal BUN/creatinine ratios (P = 0.005), and positive CRP (p = 0.022). polypharmacy as a risk factor was found the most potent for delirium {63.6 of all patients with delirium [odds ratio (OR) 2.15], P = 0.028}. Mean IQCODE score were significantly higher