The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

Tamara G. Fong, Annie M. Racine, Donna M. Fick, Patricia Tabloski, Yun Gou, Eva M. Schmitt, Tammy T. Hshieh, Eran Metzger, Sylvie E. Bertrand, Edward R. Marcantonio, Richard N. Jones, Sharon K. Inouye

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRDs). DESIGN: Prospective, observational cohort. SETTING: Inpatient hospital and study participants' homes. PARTICIPANTS: A subset (n = 267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness study. MEASUREMENTS: Delirium burden was measured using the DEL-B instrument (range = 0-40, with higher scores indicating greater burden) in caregivers (DEL-B-C) and patients 1 month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment [MoCA]), delirium presence (Confusion Assessment Method [CAM]), and delirium severity (CAM-Severity [CAM-S]) were measured during hospitalization and at 1-month follow-up. ADRD diagnosis was determined by a clinical consensus process. RESULTS: For patients with (n = 56) and without (n = 211) ADRD, both DEL-B instruments had good internal consistency. DEL-B-C scores had a median (interquartile range) among caregivers of patients with and without ADRD of 9 (5-15) and 5 (1-11), respectively (P <.05). If the patient developed delirium, caregivers experienced greater burden (β[delirium × ADRD] = −.29; P =.42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, ρ = −0.18; P =.01). Patients with ADRD who developed delirium self-reported less burden than those without ADRD (β[delirium × ADRD] = −.67; P =.044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (ρ = −0.18; P =.005) and correlated with the CAM-S in patients without ADRD (ρ = 0.38; P <.001) but not for patients with ADRD (ρ = −0.07; P =.61). CONCLUSIONS: Delirium resulted in the same degree of increased caregiver burden regardless of whether a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2019

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Delirium
Caregivers
Alzheimer Disease
Confusion
Hospitalization
Inpatients
Consensus

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology

Cite this

Fong, Tamara G. ; Racine, Annie M. ; Fick, Donna M. ; Tabloski, Patricia ; Gou, Yun ; Schmitt, Eva M. ; Hshieh, Tammy T. ; Metzger, Eran ; Bertrand, Sylvie E. ; Marcantonio, Edward R. ; Jones, Richard N. ; Inouye, Sharon K. / The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders. In: Journal of the American Geriatrics Society. 2019.
@article{6edda12664c94147bbb78c40ad5e1682,
title = "The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders",
abstract = "OBJECTIVES: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRDs). DESIGN: Prospective, observational cohort. SETTING: Inpatient hospital and study participants' homes. PARTICIPANTS: A subset (n = 267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness study. MEASUREMENTS: Delirium burden was measured using the DEL-B instrument (range = 0-40, with higher scores indicating greater burden) in caregivers (DEL-B-C) and patients 1 month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment [MoCA]), delirium presence (Confusion Assessment Method [CAM]), and delirium severity (CAM-Severity [CAM-S]) were measured during hospitalization and at 1-month follow-up. ADRD diagnosis was determined by a clinical consensus process. RESULTS: For patients with (n = 56) and without (n = 211) ADRD, both DEL-B instruments had good internal consistency. DEL-B-C scores had a median (interquartile range) among caregivers of patients with and without ADRD of 9 (5-15) and 5 (1-11), respectively (P <.05). If the patient developed delirium, caregivers experienced greater burden (β[delirium × ADRD] = −.29; P =.42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, ρ = −0.18; P =.01). Patients with ADRD who developed delirium self-reported less burden than those without ADRD (β[delirium × ADRD] = −.67; P =.044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (ρ = −0.18; P =.005) and correlated with the CAM-S in patients without ADRD (ρ = 0.38; P <.001) but not for patients with ADRD (ρ = −0.07; P =.61). CONCLUSIONS: Delirium resulted in the same degree of increased caregiver burden regardless of whether a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden.",
author = "Fong, {Tamara G.} and Racine, {Annie M.} and Fick, {Donna M.} and Patricia Tabloski and Yun Gou and Schmitt, {Eva M.} and Hshieh, {Tammy T.} and Eran Metzger and Bertrand, {Sylvie E.} and Marcantonio, {Edward R.} and Jones, {Richard N.} and Inouye, {Sharon K.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jgs.16199",
language = "English (US)",
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Fong, TG, Racine, AM, Fick, DM, Tabloski, P, Gou, Y, Schmitt, EM, Hshieh, TT, Metzger, E, Bertrand, SE, Marcantonio, ER, Jones, RN & Inouye, SK 2019, 'The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders', Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.16199

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders. / Fong, Tamara G.; Racine, Annie M.; Fick, Donna M.; Tabloski, Patricia; Gou, Yun; Schmitt, Eva M.; Hshieh, Tammy T.; Metzger, Eran; Bertrand, Sylvie E.; Marcantonio, Edward R.; Jones, Richard N.; Inouye, Sharon K.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

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T1 - The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

AU - Fong, Tamara G.

AU - Racine, Annie M.

AU - Fick, Donna M.

AU - Tabloski, Patricia

AU - Gou, Yun

AU - Schmitt, Eva M.

AU - Hshieh, Tammy T.

AU - Metzger, Eran

AU - Bertrand, Sylvie E.

AU - Marcantonio, Edward R.

AU - Jones, Richard N.

AU - Inouye, Sharon K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVES: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRDs). DESIGN: Prospective, observational cohort. SETTING: Inpatient hospital and study participants' homes. PARTICIPANTS: A subset (n = 267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness study. MEASUREMENTS: Delirium burden was measured using the DEL-B instrument (range = 0-40, with higher scores indicating greater burden) in caregivers (DEL-B-C) and patients 1 month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment [MoCA]), delirium presence (Confusion Assessment Method [CAM]), and delirium severity (CAM-Severity [CAM-S]) were measured during hospitalization and at 1-month follow-up. ADRD diagnosis was determined by a clinical consensus process. RESULTS: For patients with (n = 56) and without (n = 211) ADRD, both DEL-B instruments had good internal consistency. DEL-B-C scores had a median (interquartile range) among caregivers of patients with and without ADRD of 9 (5-15) and 5 (1-11), respectively (P <.05). If the patient developed delirium, caregivers experienced greater burden (β[delirium × ADRD] = −.29; P =.42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, ρ = −0.18; P =.01). Patients with ADRD who developed delirium self-reported less burden than those without ADRD (β[delirium × ADRD] = −.67; P =.044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (ρ = −0.18; P =.005) and correlated with the CAM-S in patients without ADRD (ρ = 0.38; P <.001) but not for patients with ADRD (ρ = −0.07; P =.61). CONCLUSIONS: Delirium resulted in the same degree of increased caregiver burden regardless of whether a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden.

AB - OBJECTIVES: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRDs). DESIGN: Prospective, observational cohort. SETTING: Inpatient hospital and study participants' homes. PARTICIPANTS: A subset (n = 267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness study. MEASUREMENTS: Delirium burden was measured using the DEL-B instrument (range = 0-40, with higher scores indicating greater burden) in caregivers (DEL-B-C) and patients 1 month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment [MoCA]), delirium presence (Confusion Assessment Method [CAM]), and delirium severity (CAM-Severity [CAM-S]) were measured during hospitalization and at 1-month follow-up. ADRD diagnosis was determined by a clinical consensus process. RESULTS: For patients with (n = 56) and without (n = 211) ADRD, both DEL-B instruments had good internal consistency. DEL-B-C scores had a median (interquartile range) among caregivers of patients with and without ADRD of 9 (5-15) and 5 (1-11), respectively (P <.05). If the patient developed delirium, caregivers experienced greater burden (β[delirium × ADRD] = −.29; P =.42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, ρ = −0.18; P =.01). Patients with ADRD who developed delirium self-reported less burden than those without ADRD (β[delirium × ADRD] = −.67; P =.044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (ρ = −0.18; P =.005) and correlated with the CAM-S in patients without ADRD (ρ = 0.38; P <.001) but not for patients with ADRD (ρ = −0.07; P =.61). CONCLUSIONS: Delirium resulted in the same degree of increased caregiver burden regardless of whether a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden.

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