Date of Award

2020-05-26

Degree Name

PhD Nursing

Dissertation Committee

Eileen Fry-Bowers, PhD, JD, CPNP, FAAN, Chairperson; Ann M. Mayo, DNSc, RN, FAAN; Kathleen M. Stacy, PhD, RN, APRN-CNS

Keywords

Delirium, Veteran, Risk Factors

Abstract

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size of 540 veterans, was used for this study. Data was collected from the electronic health record (EHR) covering a two-year period. Inclusion criteria consisted of veterans, 25 years or older, admitted to an acute or critical care unit, and length of stay greater than 48 hours.

Results: Delirium occurred in 29.6% (n=160) of veterans during hospitalization. Most cases for the delirium group were males (96.25%), white (78.8%), non-Hispanic (88.8%), served in Vietnam (61.25%), married (38.8%) and were in a medical-surgical unit (63.75%). Additionally, for the delirium group the mean age was 72.08 years (SD = 11.93)with 26.9% (n = 43) having had experienced combat. Six variables predicted the odds of having a delirium diagnosis and included older age (p2) of the variance in delirium diagnosis, and correctly classified 77.9% of the cases. Sensitivity was 44.1%, specificity was 91.6%, positive predictive value was 68.1%, and negative predictive value was 80.2%.

Implications: Veteran specific risk factors such as PTSD, SUD, and depression may increase the risk of developing delirium. Veterans with these risk factors should be routinely screened for delirium throughout their hospitalization and placed in a delirium prevention program.

Document Type

Dissertation: Open Access

Department

Nursing

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