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    Optimizing Delirium Prediction Model in The Management of Hospitalized Elderly Patients

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    This editorial discusses a study on developing a delirium prediction model for hospitalized elderly patients. The study found that infections, cognitive impairments, and decreased functional status can independently predict delirium within the first 14 days of hospitalization. Based on these risk factors, the study established a scoring system that classifies patients' delirium risk to help doctors increase awareness and prevent delirium in high-risk patients. However, the scoring system requires further validation in other settings and populations before being applied in clinical practice. The editorial encourages additional validation studies of the delirium prediction model and more clinical epidemiology research that can help clinicians manage patients.

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    Optimizing Delirium Prediction Model in The Management of Hospitalized Elderly Patients

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    This editorial discusses a study on developing a delirium prediction model for hospitalized elderly patients. The study found that infections, cognitive impairments, and decreased functional status can independently predict delirium within the first 14 days of hospitalization. Based on these risk factors, the study established a scoring system that classifies patients' delirium risk to help doctors increase awareness and prevent delirium in high-risk patients. However, the scoring system requires further validation in other settings and populations before being applied in clinical practice. The editorial encourages additional validation studies of the delirium prediction model and more clinical epidemiology research that can help clinicians manage patients.

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    This editorial discusses a study on developing a delirium prediction model for hospitalized elderly patients. The study found that infections, cognitive impairments, and decreased functional status can independently predict delirium within the first 14 days of hospitalization. Based on these risk factors, the study established a scoring system that classifies patients' delirium risk to help doctors increase awareness and prevent delirium in high-risk patients. However, the scoring system requires further validation in other settings and populations before being applied in clinical practice. The editorial encourages additional validation studies of the delirium prediction model and more clinical epidemiology research that can help clinicians manage patients.

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    52 views2 pages

    Optimizing Delirium Prediction Model in The Management of Hospitalized Elderly Patients

    Uploaded by

    peni_dwi
    This editorial discusses a study on developing a delirium prediction model for hospitalized elderly patients. The study found that infections, cognitive impairments, and decreased functional status can independently predict delirium within the first 14 days of hospitalization. Based on these risk factors, the study established a scoring system that classifies patients' delirium risk to help doctors increase awareness and prevent delirium in high-risk patients. However, the scoring system requires further validation in other settings and populations before being applied in clinical practice. The editorial encourages additional validation studies of the delirium prediction model and more clinical epidemiology research that can help clinicians manage patients.

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    EDITORIAL

    Optimizing Delirium Prediction Model in the Management


    of Hospitalized Elderly Patients
    Kuntjoro Harimurti1,2
    Department of Internal Medicine, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital.
    Jl. Diponegoro no. 71, Jakarta Pusat 10430, Indonesia.
    2
    Center for Clinical Epidemiology and Evidence-Based Medicine, Faculty of Medicine, University of IndonesiaCipto Mangunkusumo Hospital, Jakarta, Indonesia. Correspondence mail: [email protected].
    1

    One of consequences of aging population


    in almost all part of the world is increasing
    rate hospitalization of elderly patients.1 Acute
    conditions are the most reasons for hospitalization
    among this population, but they are usually
    already have many chronic comorbidities and
    impairments resulting more complications and
    difficult managements in hospital.2 One of the
    common problems among hospitalized eldery
    patients is delirium, which can already occured
    when patients were admitted or develop during
    hospitalization. 3 Some studies showed that
    prevalence of delirium on admission among
    elderly patients are between 10-31%, and the
    incidence of delirium during hospitalization are
    3-29%, depends on in what unit patients were
    hospitalized.4
    Delirium can be a sign of other serious
    medical conditions, such as infections, metabolic
    disturbances, hypoxia, dehydration, or drugs
    side effect. Delirium commonly occurs in
    patients with multiple chronic diseases, cognitive
    impairment, decrease of functional status,and
    malnutrition.3 Delirious patients have worse
    outcomes compared to those who not delirious, in
    terms of length of hospital stay, loss of functional
    status, prolong cognitive impairment, and
    higher rate mortality.4 Nevertheless, diagnosis
    of delirium frequently missed by doctors or
    other hospital team, either because the diagnosis
    of delirium difficult to established or because
    low awareness on those who have high risk for
    development of delirium.3
    In this issue, Isfandiaty et al. report their
    retrospective cohort study on prediction of
    delirium in hospitalized elderly patients. 5
    Based on previously identified risk factors and
    precipitating factors, authors found that infections

    (with and without sepsis), cognitive impairments,


    and decrease of functional status are independent
    predictors for development of delirium during
    first 14-days of hospitalization. Authors also
    established a prediction model which can be
    easily applied in daily clinical practice through
    a scoring system. Using this scoring system, a
    clinician can classified an elderly patient into her/
    his risk for development of delirium and therefore
    increasing awareness for the delirium occurrence
    during hospitalization.
    Of course, the scoring system is not meant
    to take over the job of the doctor. It is intended
    to help doctor make decisions by providing
    more objective estimates of probability for
    developing delirium in hospitalized elderly
    patients, as a supplement to other relevant clinical
    information. In high risk patients, doctor should
    give more attention and do more effort to prevent
    delirium based on known predisposing and
    precipitating factors. In addition, the information
    can also incorporated in patient and family
    education regarding the prognosis of patients and
    complication due to hospitalization.
    The use of this scoring system is not straight
    forward, it needs validationboth internal and
    external validationsbefore it can be applied
    in clinical practice.6 Therefore, we encourage
    the authors and also other researchers to do the
    validation study, to test whether this delirium
    prediction model is also valid when used in
    other setting and population. Furthermore,
    considering this kind of research (defined as
    clinical epidemiology research) have potential
    useful application in clinical practice, we
    also encourage other colleagoues to submit
    their clinical epidemiology researches in this
    Journal. What we mean of clinical epidemiology

    Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine

    271

    Kuntjoro Harimurti

    researches are the researches which have aims


    that compatible to clinical challenges in daily
    practice, i.e.: to establish diagnosis, to determine
    etiology/risk factors of a disease, to predict
    prognosis, and to choose best treatment. We
    believe the evidences from clinical epidemiology
    researches will be useful for our colleagoues who
    works as clinicians in the management of their
    patients.

    272

    Acta Med Indones-Indones J Intern Med


    REFERENCES
    1. Strunk BC, Ginsberg PB, Banker MI. The effect of
    population aging on future hospital demand. Health
    Affair. 2006;25:w141-9.
    2. Nagamine M, Jiang HJ, Merril CT. Trend in elderly
    hospitalization. Healthcare cost and utilization project.
    Agency for healthcare and quality. Available from:
    http://www.hcup-us.ahrq.gov/reports/statbriefs/sb14.
    pdf (accessed October 25th, 2012).
    3. Young J, Inouye SK. Delirium in older people. BMJ.
    2007;334:842-6.
    4. Siddiqi N, House AO, Holmes JD. Occurrence and
    outcome of delirium in medical in-patients: a systematic
    literature review. Age Ageing. 2006;35(4):350-64.
    5. Isfandiaty R, Harimurti K, Setiati S, Roosheroe AG.
    Incidence and predictors for delirium in hospitalized
    elderly patients: a retrospective cohort study. Acta Med
    Indones-Indones J Intern Med. 2012;44(4):290-7.
    6. Altman DG, Vergouwe Y, Royston P, Moons KGM.
    Prognosis and prognostic research:validating a
    prognostic model. BMJ. 2009;338:1432-5.

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