Latent class analysis of the multivariate Delirium Index in long-term care settings. (3rd May 2018)

• Record Type: Journal Article
• Authors: Ciampi, Antonio; Bai, Chun; Dyachenko, Alina; McCusker, Jane; Cole, Martin G.; Belzile, Eric
• Is Part Of: International psychogeriatrics. Volume 31:Number 1(2019)
• Page Start: 59
• Page End: 72
• Publication Date: 2018-05-03
• Subjects: delirium, -- longitudinal, -- old, -- long-term care, -- Delirium Index, -- hidden Markov model, -- latent class; Geriatric psychiatry -- Periodicals; 618.9768905
• DOI: 10.1017/S1041610218000510
• Languages: English
• ISSNs: 1041-6102

Abstract

ABSTRACT: Background: A few studies examine the time evolution of delirium in long-term care (LTC) settings. In this work, we analyze the multivariate Delirium Index (DI) time evolution in LTC settings. Methods: The multivariate DI was measured weekly for six months in seven LTC facilities, located in Montreal and Quebec City. Data were analyzed using a hidden Markov chain/latent class model (HMC/LC). Results: The analysis sample included 276 LTC residents. Four ordered latent classes were identified: fairly healthy (low "disorientation" and "memory impairment, " negligible other DI symptoms), moderately ill (low "inattention" and "disorientation, " medium "memory impairment"), clearly sick (low "disorganized thinking" and "altered level of consciousness, " medium "inattention, " "disorientation, " "memory impairment" and "hypoactivity"), and very sick (low "hypoactivity, " medium "altered level of consciousness, " high "inattention, " "disorganized thinking, " "disorientation" and "memory impairment"). Four course types were also identified: stable, improvement, worsening, and non-monotone . Class order was associated with increasing cognitive impairment, frequency of both prevalent/incident delirium and dementia, mortality rate, and decreasing performance in ADL. Conclusion: Four ordered latent classes and four course types were found in LTC residents. These results are similar to those reported previously in acute care (AC); however, the proportion of very sick residents at enrolment was larger in LTC residents than in AC patients. In clinical settings, these findings could help identify participants with a chronic clinical disorder. Our HMC/LC approach may help understand coexistent disorders, e.g. delirium and dementia.