Presentation Abstract

Delirium Among AIDS Patients in a Long Term Care Facility. KK Uldall, J Berghuis, B Lalonde. University of Washington, Seattle.

Objective: To determine the frequency of AIDS-associated delirium in patients residing at a long term care facility and describe factors associated with delirium episodes.

Methods: Charts of 137 AIDS patients (134 male, 3 female) who died at or were discharged from a long term care facility in 1994 were reviewed. Demographic information, past and current medical conditions, and medication usage were extracted from the medical record. The presence or absence of delirium was determined using the Confusion Assessment Method (CAM), a diagnostic algorithm. Interrater reliability checks were performed on 25% of the 137 charts reviewed following a random selection process. Chi-square analyses, including Bonferroni corrections, were used to test for differences between the delirious and non-delirious patient groups. Odds ratios (OR) and confidence intervals (CI) were determined for delirium associated with specific medications.

Results: The mean age of patients was 38.5 years (range 25-76; sd 8.53). Eighty percent of patients were Caucasian, 10% African American, 5% Asian/Pacific Islander, and 6% other race. Delirium was diagnosed prior to the study in only one patient. Delirium was diagnosed via chart review, using the CAM, in 46% (n=63) of patients; interrater reliability was good (=0.78). Seventeen percent of patients (n=11) had more than one episode of delirium during their stay. There were no significant differences between the delirious and non-delirious patient groups with respect to age, race, relationship status, HIV exposure category, source of admission, source of payment, or AIDS-defining conditions. The average length of stay at the facility was 77.9 days (range 1-415; sd 75.8). Eighty-eight percent of patients died at the facility; delirious patients were more likely to die at the facility than non-delirious patients (X2 8.2;df 1; p<0.004). Factors associated with delirium in this study include: fever (47.6%); medication effect (46.0%); infection (20.6%); central nervous system condition (11.1%); metabolic abnormality (7.9%); pulmonary problem (6.3%); hepatic dysfunction (4.8%); pain (4.8%); and other (e.g. anemia, trauma, sleep deprivation) causes (15.8%). Specific medications associated with delirium in AIDS patients include narcotics (OR 7.9; CI 3.1-19.8), benzodiazepines (OR 4.6; CI 1.8-11.9), anticholinergic/antihistaminics (OR 4.4; CI 1.5-12.9) and steroids (OR 3.0; CI 1.2-7.2).

Conclusions: Delirium is a common problem among AIDS patients in long term care facilities. It is poorly recognized and therefore, undertreated. Further study is needed to assess the impact of physiologic assessment and judicious medication usage on episodes of delirium.

Contact: Karina K. Uldall, 901 Boren Ave., Suite 1100, Seattle, WA 98104; 206.221.4944 (phone), 206.221.4945 (fax), email: keegan@u.washington.edu.

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