Prevalence and interconnectedness of delirium, dementia, and frailty pathways in clinical settings: a survey of geriatricians across Europe

PURPOSE: To explore the prevalence, overall and in different clinical settings, and interconnectedness, of delirium, dementia, and frailty clinical pathways across Europe.

METHODS: An online anonymous survey was distributed via the mailing list of the European Geriatric Medicine Society (EuGMS), national member groups and the authors' professional networks, targeting geriatricians, or trainees in their final 2 years of specialist geriatric training, working in a hospital, rehabilitation, post-acute care or residential setting in a European country. Quantitative data were summarized using descriptive statistics and frequency distributions. Inductive content analysis was used to interpret open-text questions.

RESULTS: The 240 respondents were predominantly female (63%), with a 6:1 consultant to trainee ratio and marked underrepresentation of Eastern Europe. Integrated care pathways (current or in-development) for delirium, dementia, or frailty are reported in 48-78% of settings. Dementia and delirium pathways are common except in radiology, neurosurgery, and operating/recovery settings. Frailty pathways are less common overall, and specific frailty staff are less common than dementia or delirium staff. Dementia pathways commonly incorporate delirium screening (76%) and prevention (73%), but less commonly frailty screening (61%). Similarly, delirium pathways often provide guidance on formal dementia diagnosis (62%) but less than half incorporate frailty screening/assessment (46%). Notably, only 19% of delirium pathways differentiate between managing delirium and delirium-superimposed-on-dementia (DSD). Frailty pathways frequently incorporate cognitive assessment (81%) and delirium screening/assessment (75%), but only 57% incorporate delirium prevention.

CONCLUSION: Dementia and delirium pathways are more common and more integrated and inclusive of each other than frailty pathways. More unified approaches could maximize the value of staff time, reduce duplications, and avoid a siloed approach to the care of older people.