Delirium-like symptomatology in community-dwelling older adults with dementia

Background: Delirium, a sudden and acute state of confusion, is known to be more prevalent in hospitalised older adults with dementia and is associated with lower levels of functioning after the delirium episode; yet, the literature on estimates of delirium prevalence in community-dwelling older adults with dementia is scarce. The aim of this study was to define and determine the frequency of delirium-like symptoms in two different samples of community-dwelling persons living with dementia, as reported by their family caregivers. 'Delirium-like symptoms' is a concept that specifies an occurrence of cognitive and behavioural symptoms, provoking suspicion of delirium, that represent a sudden and unusual deleterious change in a community-dwelling person living with dementia that can be identified by family caregivers and prompt healthcare seeking behaviours.

Methods: The frequencies of delirium-like symptoms were assessed from two intensive longitudinal 21-day diary studies. Caregivers reported on presence of sudden and unusual cognition and behaviours each day. Descriptive statistics were used to determine the number of caregivers who reported delirium-like symptoms.

Results: Family caregivers (n = 50, n = 102) were predominately non-Hispanic White (75%, 61%), female (94%, 85%), and a child (60%, 59%) of the care-recipient and completed 1389 and 1739 diaries from the first and second study respectively. Caregivers reported delirium-like symptoms for 12 (24%) and 27 (27%) of care-recipients.

Conclusion: Other studies of delirium in community-dwelling persons living with dementia have reported similar rates. More research is needed to understand the dynamic context of delirium in community settings to improve the care provided to them by their family caregivers and clinicians in services such as home, primary, and specialty healthcare.