Gerontological Nursing Interventions Research Center (GNIRC)

Title: Detect of Drug-Induced Delirium
Principal Investigator: Ryan Carnahan, Pharm D.
Study Site: The University of Iowa

Abstract
Goal: To design a tool to quanitfy medication-related risk of delirium in long-term care patients.

Objectives: Quantify the risk of delirium related to medications. Accurately quantify anticholinergic burden in subjects with help of the serum anticholinergic activity (SAA) assay. Investigator specific cognitive deficits associated with medications. Investigate the association of SAA with delirium, depressive symptoms, pain, inattention, other specific cognitive deficits, urinary retention, urinary tract infections, hospitalizations, falls, and mortality. Investigate the association of medications with delirium subtype (hypoactive, hyperactive, mixed).

Methods: Subjects are long-term care residents in 8 rural Iowa facilities. Cognitive status, medications, and pain status will be followed over one month in a longitudinal study. SAA will be measured once. A three-month follow-up period will assess long-term outcomes including falls, hospitalizations, and mortality. Statistical analysis will quantify the association of medications with delirium by class (narcotics, bensodiazepines, anticholinergics, miscellaneous), number, recent addition of medication, and withdrawal of certain medications. SAA levels will be analyzed for utility in assessing anticholinergic burden. Pain will be controlled for when assessing the impact of narcotics. Baseline cognitive status will be included in the analysis. Secondary analyses will investigate the association of medications and classes with specific cognitive deficits and delirium sub-type. SAA will be analyzed for association with numerous problems related to anticholinergics as stated above.