In the multivariate analysis, only age, Barthel index, and urinary catheterization were associated with the onset of delirium during hospitalization (Table 2). Intravenous fluid therapy lasted longer for patients who experienced delirium (M = 6 days and SD = 5 days vs. M = 3 days and SD = 5 days; p <; .001). A similar trend was seen for the duration of urinary catheterization, but the difference was not statistically significant (M = 6 and SD = 7 vs. M = 5 and SD = 7; p = .07).
Patients in internal medicine departments are usually aged and frequently experience more than one disease. In Spain, a recent study showed that the mean age of patients admitted to internal medicine nursing units of acute care hospitals has increased by 19.3 years over the last 20 years (Casademont, Francia, & Torres, 2011). In other studies, the mean age was between 70 and 72 years, and the average number of diagnosis per episode was 5.4 (Barba Martín et al., 2009; de San Román y de Terán & Guijarro Merino, 2006). In this study, the mean age of patients was above the one observed in the analysis of the basic minimum collection of data of Spanish Internal Medicine Services and that of American studies (Everett, Uddin, & Rudloff, 2007). Given the progressive aging of the population, delirium may become an epidemic affecting hospitalized or institutionalized patients, with the ensuing increase of mortality and economic expenses and a corresponding deterioration of the quality of life of patients and caregivers.
Some multicomponent interventions have proved effective in preventing the onset of delirium in elderly inpatients (Inouye et al., 1999). However, once delirium had occurred, intervention was less effective. Therefore, the most advisable strategy is to take proactive steps against risk factors associated with it. A significant find in this study was the fact that urinary catheterization is independently associated with the onset of delirium. Bladder catheters were already associated with the appearance of urinary tract infections, and yet, it is still commonly performed, often unnecessarily (Gokula, Hickner, & Smith, 2004). Its association with delirium remains widely unacknowledged, albeit, it was described years ago (Inouye & Charpentier, 1996; Van Rompaey et al., 2009). Few prospective studies assess the association of urinary catheterization with a new onset of delirium (Inouye & Charpentier, 1996). However, strategies seeking to improve patient mobility that included restricted urinary catheterization have been associated with a lower occurrence of delirium (Inouye, Bogardus, Williams, Leo-Summers, & Agostini, 2003; Inouye et al., 1999). In this study, average duration of urinary catheterization was about 1 day longer in patients with delirium (the difference was not statistically significant). Nevertheless, before proceeding to urinary catheterization, it is prudent to assess the risk of delirium and the need for catheterization. Elimination of urinary catheters as soon as possible may help to decrease the onset of delirium, but more studies are needed.
It was found that intravenous use of fluids was more frequent and lasted longer in patients with delirium. It is known that delirium increases with the number of perfusions (Van Rompaey et al., 2009). Intravenous therapy implies mobility restrictions for many patients, especially the older adults, and immobility is associated with the onset of delirium.
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