A world-wide study on delirium assessments and presence of protocols
Authors: Nydahl Peter , Liu Keibun , Bellelli Giuseppe , Benbenishty Julie , van den Boogaard Mark , Caplan Gideon , Chung Chi Ryang , Elhadi Muhammed , Gurjar Mohan , Heras-La Calle Gabi , Hoffmann Magdalena , Jeitziner Marie-Madlen , Krewulak Karla , Mailhot Tanya , Morandi Alessandro , Nawa Ricardo Kenji , Oh Esther S , Collet Marie O , Paulino Maria Carolina , Lindroth Heidi , von Haken Rebecca ,   the WDAD Study Group, Abdalgany Ahmed Gaber Ahmed , Abdelmohsen Sarah Magdy , Aburaas Amjad , Aggar Christina , Albakosh Bashir Abobaker , Alhamdan Hamza Ismail Ahmad , Aljbali Akram Waled Rajab M , Alkandari Farah , Alkaseek Akram , Anders Daniel , Anderson Marsali , Ashkenazy Shelly , Avelino Thiago , Bail Kasia Siobhan , Bakri Ashraf , Baroum Alaa Mohamed Ali , Blackwood Bronagh , Brendt-Müller Jennifer , Brobeil Angelika , Burke Richard , Byrnes Tru , Cacciatore Stefano , Cahill Maria , Canelas Maria Ana , Carroll Ida , Conley Amy , Costello Maria , Cotton Shannon , Couser Mandy , Salgado Ana Rita Cunha , Cusworth Elizabeth , Cvoro Vera , Deosaran Jordanna , Diebels Merel , Docherty Elaine A , Dossow Vera , Drennan Megan , Egdeer Akram Amin , Eichelsheim Patrick , Elagili Aissha Ali Saleh , Elsahl Saifaleslam Jamal , Elshaikh Hajer Alsadeg Mohammed , Emme Christina , Exl Matthias Thomas , Fathi Azza , Feige Melanie , Fiest Kirsten , Fong Marleta Irene Joy , Fuchita Mikita , Gaffney Carol , Vich Carola Gimenez-Esparza , Feldmann Nicole , Fitzgerald Rachel , Fitzpatrick Neasa , Fong Marleta Irene Joy , Goldberg Maria Adela , Golüke Nienke , Graaf Mirjam , Groenewald Engelina , Gross Renate , Segers Camilla Grube , Hadi Renate , Hamdan Qusai Ahmad Hasan , Hamida Bahaeddin Ben , Hamza Mohamed Hassan , Hetland Breanna , Hopkins Jane Adele , Hopkins John , Ibrahim Sarah Ahmed Atef Mohamed , Imbriaco Guglielmo , Inoue Shigeaki , Jeyaseelan Arveen , Kadhim Ali Jawad , Kohler Sabrina , Kooken Rens , St. Korompeli Anna , Krüger Lars , Khutwah Ayman Salim Abu , Lange Puck , Liefrink Sharon , Lin Yu-min , Loo Shi Pei , Rodrigues Sara Beatriz Lopes , MacDonald Allan , Madders Gillian , Massaro Claudia , Maya Kerri , Manioudaki Sofia , McAndrew Natalie , McKenna Stewart , Coimbra Isabel Maria Metelo , Miranda Teresa , Mohamed Mohamed Anwar Abdelsalam , Mohammed Mushin Mohammed Elhadi Agbna , Mulkey Malissa , Naeem Fariha , Nakamura Kensuke , Nam Mi-Ryeo , Newman Elaine , Nicol Renae , Noonan Claire , Lopes Maria Inês Nunes Oliveira , Otmani Zina , Olotu Cynthia , Ornago Alice Margherita , O’Reilly Susan , Ozorio Valerie , Palakashappa Jessica , Pandya Tej , Papadea Panagiota , Papanikolaou Metaxia , Penfold Rose S , Pinardi Elena , Pereira Inês Filipa Pinto , Premathilaka Chirantha , Pop-Purceleanu Monica , Puchegger Marlene , Qalhoud Nouralddeen Mohammed , Quinn Terence J , Raasing Maike , Ragheb Dalia Talaat , Rajhans Prasad , Ramadan Nuri , Rubel Mushabbir Hossain , Sainsbury Kate , Salis Francesco , Schimböck Florian , Schmädig Roman , Schoon Yvonne , Sethia Deepak , Sextl Edith , Shah Bhagyesh , Shaout Dua’a , Sharabi Alaa Fouad , Shields Lynn , Smith Kendall , Dam Linda Smulders-van , Soiza Roy L , Spiegler Andrea , Stocks Lucy , Sumerauer Stefan , Tam Stephanie , Tan Aik Haw , Timmons Suzanne , Tohsche Peter , Torres Raquel Gouveia , Toth Chantal , Tsolaki Vasiliki , Tousgaard Iben , Castro Roberta Esteves Vieira , Vogt Birgit , Walsh Erica , Ward-Stockham Kristel , Webb-St. Mart Melinda , Wefer Franziska , Wijnen-Meijer Mariajne Elisabeth , Wøien Hilde , Zastrow Inke , Zazzara Maria Beatrice 
Published: July 2024

Abstract

Background
Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities.

Objective
To assess the worldwide use of validated delirium assessment tools and the presence of delirium management protocols.

Design
Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023.

Setting
Cross-sectional online survey including hospitals, rehabilitation and long-term facilities.

Methods
Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers.

Results
Data from 44 countries, 1664 wards/units and 36 048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol [n = 1094/1664, 66.8%] were more likely to use a validated delirium test than those without a protocol [odds ratio 6.97 (95% confidence interval 5.289–9.185)]. The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions.

Conclusion
Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium.