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The relationship between acute confusion and select patient characteristics and environmental variables in elderly patients admitted to an acute orthopaedic service

University of British Columbia

Acute confusion is a common complication of hospitalization in the elderly that contributes to the mortality and morbidity of this patient population. Although elderly individuals admitted to hospital with an orthopaedic condition consistently present with numerous risk factors associated with the development of acute confusion, not all develop the condition. The purpose of this prospective, descriptive, correlational study was to determine if there are specific patient characteristics and environmental variables associated with the development of acute confusion in elderly patients admitted to hospital with an orthopaedic condition, and if these factors could distinguish those elderly patients who become acutely confused from those who do not. Miller's Functional Consequences Theory (1990) provided a framework for examining the etiology of acute confusion in this population. A non-probability convenience sample of 41 subjects participated in the study. Participants received serial assessments of their cognitive status using the Folstein Mini- Mental State Exam (1975), the Clinical Assessment of Confusion - A (revised) (1990), and the Visual Analogue Scale - Confusion (1986). A determination of the occurrence of acute confusion was based on a predetermined change in score on all three assessment tools used. Fourteen (34%) of the participants developed acute confusion during the first week of hospitalization. Factors significantly associated with the development of acute confusion included: admission to a particular ward, a higher emotional stress score, a higher level of dependency prior to admission, a pre-existing cognitive impairment, and a primary diagnosis of fracture. The findings of this preliminary study support a multiple factor etiology for acute confusion within this patient population. Elderly patients admitted to hospital may have common pre-existing psychosocial risk factors that put them at risk for the development of acute confusion regardless of their physiologic risk. In addition, the findings suggest that the experience of an unplanned event, such as a hip fracture may be a differentiating characteristic of patients who develop acute confusion within the general orthopaedic patient population.

Thesis/Dissertation

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2009-01-09

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http://hdl.handle.net/2429/3493

Nursing

University of British Columbia

UBCV

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