The DETEcT Study - Delirium in Elderly paTiEnts Admitted to Trauma

Study Overview
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Brief Summary
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Primary objectives are to define incidence and prevalence of Delirium in an elderly population admitted to the Department of Orthopedics and Traumatology and, in the postoperative phase, in the high Dependency Unit as well as to determine the presence of risk factors. Secondary objectives are to determine mean hospital stay, rates of complications as well as in-hospital mortality and at 1-3 and 12 months after discharge, functional recovery and cognitive outcomes at 1, 3 and 12 moths follow-up.

Detailed Description
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The aging of population as well as the increased life expectancy put progressively urgent demands about the adequacy of the level of care provided in a hospital environment to ensure clinical pathways tailored on the needs of each individual patient. On the other hand, the gradual evolution of Health Care systems to care for the acute, with increasing levels of specialization often technologically driven, cannot and must not neglect these aspects of personalization of care protecting the elderly frail patient, because of its intrinsic characteristics. In such a context, evaluation of frailty undertakes not only the meaning of prevention and promotion of quality of life but it takes in account important issues for patient's safety and the economic weight it entails. Delirium (acute confusional state) is a complex syndrome which frequently occurs in the elderly hospitalized population. Development of Delirium is associated with negative outcomes such as a longer hospital stay, a higher rate of complications, cognitive and functional decline, loss of independence, institutionalization, and, ultimately, death. For skilled healthcare professionals, on the other hand, it represents a challenging condition because a prompt and accurate diagnosis with the introduction of all those prevention and non-pharmacological measures may reduce the incidence, severity and/or duration of Delirium and improve functional recovery. Therefore the meaning of conducting such an observational study is also to provide evidence of patients' needs and address the on-ground educational aspect for healthcare professionals in a daily practice. The purposes of the study are to determine the incidence and prevalence (before and after surgery) of Delirium in an elderly population admitted to the Department of Orthopedics and Traumatology and in the High Dependency Unit in the postoperative phase as well as to determine the risk factors for developing such a condition. Secondary objectives are mean hospital stay, rates of complications as well as in-hospital mortality and at 1, 3 and 12 months after discharge, functional recovery and cognitive outcomes at 1, 3 and 12 months follow-up.

Official Title
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The DETEcT Study - Delirium in Elderly paTiEnts Admitted to Trauma

Conditions
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Delirium, Bone Fractures, Multiple Trauma

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with any medical condition with an age of 65 years and older Exclusion Criteria: Impossibility to give an informed consent; refusal

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of Delirium, its association with risk factors and their prognostic value | Patients are evaluated on admission with: IqCode Katz Index of Independence in Activities of Daily Living (ADL) The Lawton Instrumental Activities of Daily Living (IADL) Scale The Barthel Index for Mobility The Confusion Assessment Method (CAM) The 4AT Scale Presence of Risk Factors | At hospital admission | 
| Incidence of Delirium, its association with risk factors and their prognostic value | Detection of any change in clinical condition. Patients are evaluated with: The Confusion Assessment Method (CAM) The 4AT Scale | At hospital admission and for the next 48 hours | 
| Incidence of Delirium, its association with risk factors and their prognostic value | Detection of any change in clinical condition. Patients are evaluated with: The Confusion Assessment Method (CAM) The 4AT Scale | After surgery and for the next 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality rates |  | In-Hospital | 
| Mortality rates |  | At 1,3 and 12 months follow-up | 
| Mean Hospital Stay |  | In-Hospital | 
| Clinical Complications |  | In-Hospital | 
| Changes in functional capabilities | Patients are evaluated with: Katz Index of Independence in Activities of Daily Living (ADL) The Lawton Instrumental Activities of Daily Living (IADL) Scale The Barthel Index for Mobility | At 1, 3 and 12 months follow-up |