A Quality Improvement Study on Delirium Awareness Day: In Pursuit of Missed Delirium Diagnoses

Abstract

The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition ( DSM-5 ) criteria. Prevalence of delirium according to clinical impression was 3.3% ( n = 4), whereas prevalence was 12.4% ( n = 17) according to DSM-5 criteria and 13.8% ( n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 ( p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [ Journal of Gerontological Nursing, 48 (8), 43–51.]