Acute confusional state in elderly orthopaedic patients: Factors of importance for detection in nursing care

Objectives. The aims of this study were to identify factors of significance in the development of acute confusional state (ACS) and the differences be tween patients who developed ACS and those who did not. Method and Results. Assessment, observations and interviews with 505 patien ts admitted to an orthopaedic clinic revealed that 51 patients developed AC S during their in-hospital stay. Patients admitted for hip fracture had a h igher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthros or gonarthros (3.6%). The highest hazard ratio for ACS was s everal other physical diseases 15.94 (CI: 4.60-55.31 and p-value <0.00001) and the lowest was age 1.10 (CI: 1.04-1.15 and p-value <0.0002). The ACS la sted from 1 to 9 days, and patients had one (N=42), two (N=8) or three epis odes (N=1) of confusion during their stay on the ward. More patients who de veloped ACS before surgery had two or more confusional episodes and emergen cy patients developed ACS more rapidly. The ACS lasted longer in patients w ith a higher score on the OBS scale at admittance and with rapid developmen t of ACS. Conclusions. Acuteness in the situation seems an important risk indication for ACS in the elderly. Awareness of factors associated with the developmen t of ACS makes it possible to more systematically identify those at risk, f or instance by systematic assessment in the first interview with the patien t on admission to hospital. Copyright (C) 2001 John Wiley & Sons, Ltd.