Impact of dementia care resources on delirium screening in people with dementia in acute hospitals in Ireland

Background
Dementia is a chronic cognitive disorder, where superimposed delirium (DSD) worsens outcomes; early detection and management of DSD are essential to optimise prognosis and recovery.

Objective
To examine whether dementia-specific resources influence delirium screening practices for in-patients with dementia in Irish acute hospitals.

Methods
Data from the Second Irish National Audit of Dementia (INAD-2; 2019) was retrospectively analysed, using univariate and multivariate logistic regression models.

Results
Of 893 healthcare records (55% women; median 84 years; 62% admitted from home; 93% unscheduled admissions; median stay 10 days), 19.7% had delirium screening performed, mostly using the 4AT (76.4%). Factors influencing delirium screening performance included dementia quality improvement (QI) teams, Odds Ratio (OR)2.9; dementia champions, OR2.2; geriatric ward care, OR2.1. Independent influencers were staff dementia training (adjusted OR2.8; 95% CI 1.8-4.3), dementia pathways/bundles (aOR2.8; 1.7-4.5) and dementia precipitating the admission (aOR2.4; 1.3-4.2). Length of stay had minimal effect (aOR 1.01); the hospital complexity had no impact.

Conclusion
This study suggests that dementia pathways and staff dementia training independently influence delirium screening in hospitalised patients with dementia, highlighting priorities for strengthening practice to detect DSD.