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November 2024 </div> <div class="label-in-progress"> (In Progress) </div> </div> </a> </div> </div> <div class="content-nav"> <div class="widget widget-ArticleJumpLinks widget-instance-OUP_ArticleJumpLinks_Widget"> <h3 class="contents-title" >Article Contents</h3> <ul class="jumplink-list js-jumplink-list"> <li class="section-jump-link head-1" link-destination="494610715"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610715">Abstract</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610717"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610717">Key Points</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610719"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610719">Introduction</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610723"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610723">Methods</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610739"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610739">Results</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610761"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610761">Discussion</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610779"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610779">Conclusion</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610781"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610781">Acknowledgements</a> </div> </li> <li class="section-jump-link head-1" link-destination="494610783"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#494610783">Declaration 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Access' ></i> </h1> </div> <div class="wi-authors at-ArticleAuthors"> <div class="al-authors-list"> <div class="meta-authors--limited"> <span class="al-author-name js-flyout-wrap"> <button type="button" class="linked-name js-linked-name-trigger btn-as-link">Heidi Lindroth</button><span class='delimiter'>, </span> <span class="al-author-info-wrap arrow-up"> <div class="info-card-author authorInfo_OUP_ArticleTop_Info_Widget"> <div class="name-role-wrap"> <div class="info-card-name"> Heidi Lindroth <span class="info-card-footnote"><span class="xrefLink" id="jumplink-cor1"></span><a href="javascript:;" reveal-id="cor1" data-open="cor1" class="link link-ref link-reveal xref-default"></a></span> </div> </div> <div class="info-card-affilitation"> <div class="aff"><div class="institution">Department of Nursing</div>, Division of Nursing Research, <div class="institution">Mayo Clinic</div>, Rochester, MN, <div class="country">USA</div></div><div class="aff"><div class="institution">Center for Aging Research</div>, Regenstrief Institute, Center for Health Innovation and Implementation Science, School of Medicine, <div class="institution">Indiana University</div>, Indianapolis, IN, <div class="country">USA</div></div> </div> <div class="info-author-correspondence"> <div content-id="cor1">Address correspondence to: Heidi Lindroth, Department of Nursing, Division of Nursing Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. 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class="orchid-icon" alt="ORCID logo" aria-hidden="true" src="//oup.silverchair-cdn.com/Themes/Silver/app/img/mini-icon.png"/>  https://orcid.org/0000-0002-5178-0364 </a> </div> <div class="info-card-search-label"> Search for other works by this author on: </div> <div class="info-card-search info-card-search-internal"> <a href="/ageing/search-results?f_Authors=Peter+Nydahl" rel="nofollow">Oxford Academic</a> </div> <div class="info-card-search info-card-search-pubmed"> <a href="http://www.ncbi.nlm.nih.gov/pubmed?cmd=search&term=Nydahl P">PubMed</a> </div> <div class="info-card-search info-card-search-google"> <a href="http://scholar.google.com/scholar?q=author:%22Nydahl Peter%22">Google Scholar</a> </div> </div> </span> </span> <span class="al-author-name-more js-flyout-wrap"> <button type="button" class="linked-name js-linked-name-trigger btn-as-link">For the WDAD Study Team</button><span class='delimiter'></span> <span class="al-author-info-wrap arrow-up"> <div class="info-card-author authorInfo_OUP_ArticleTop_Info_Widget"> <div class="name-role-wrap"> <div class="info-card-name"> For the WDAD Study Team </div> </div> <div class="info-card-search-label"> Search for other works by this author on: </div> <div class="info-card-search info-card-search-internal"> <a href="/ageing/search-results?f_Authors=For+the+WDAD+Study+Team" rel="nofollow">Oxford Academic</a> </div> <div class="info-card-search info-card-search-pubmed"> <a href="http://www.ncbi.nlm.nih.gov/pubmed?cmd=search&term=For the WDAD Study Team">PubMed</a> </div> <div class="info-card-search info-card-search-google"> <a href="http://scholar.google.com/scholar?q=author:%22For the WDAD Study Team%22">Google Scholar</a> </div> </div> </span> </span> </div> </div> <div class="al-author-name al-author-footnotes"> <div class="al-author-info-wrap arrow-up"> <div class="widget widget-SingleSection widget-instance-OUP_FootnoteSection"> <div content-id="afn1" class="footnote"><span class="fn"><div class="footnote-content"><p class="footnote-compatibility">Acknowledgement of Collaborative Authorship: The World Delirium Awareness Day (WDAD) Study Team consists of: Ahmed Gaber Ahmed Abdalgany, MBBCH, Sarah Magdy Abdelmohsen, M.D., Amjad Aburaas, M.D., Christina Aggar, M.D., Bashir Abobaker Albakosh, M.D., Hamza Ismail Ahmad Alhamdan, M.D., Akram Waled Rajab M Aljbali, M.D., Farah Alkandari, M.D., Akram Alkaseek, MBBCh, MRCS, Daniel Anders, R.N., Marsali Anderson, MB ChB, BSc, Thiago Avelino, Kasia Siobhan Bail, Ashraf Bakri, M.D., Alaa Mohamed Ali Baroum, Julie Benbenishty, Ph.D., MNS, R.N., Bronagh Blackwood, Ph.D., Jennifer Brendt-Müller, MSc, Angelika Brobeil, BBA, Richard Burke, M.D., Tru Byrnes, D.N.P., Stefano Cacciatore, M.D., Maria Cahill, MSc, Maria Ana Canelas, Ida Carroll, MSc, Amy Conley, MbChB, Maria Costello, M.D., Shannon Cotton, R.N., Mandy Couser, BSc, Ana Rita Cunha Salgado, M.D., Elizabeth Cusworth, MS, Vera Cvoro, M.D., Jordanna Deosaran, M.D., Merel Diebels, MSc, Elaine A. Docherty, MHp, Vera von Dossow, M.D., Megan Drennan, M.D., Akram Amin Egdeer, MBBCh, Patrick Eichelsheim, MANP, Aissha Ali Saleh Elagili, M.D., Saifaleslam Jamal Elsahl, M.D., Hajer Alsadeg Mohammed Elshaikh, M.D., Christina Emme, Ph.D., Matthias Thomas Exl, MSc, Azza Fathi, M.D., Melanie Feige, Dipl. Paed., Kirsten Fiest, Ph.D., Marleta Irene Joy Fong, MsN, Mikita Fuchita, M.D., Carol Gaffney, M.D., Carola Gimenez-Esparza Vich, M.D., Nicole Feldmann, MSc, Rachel Fitzgerald, M.D., Neasa Fitzpatrick, M.D., Marleta Irene Joy Fong, MN CN, Maria Adela Goldberg, M.D., Nienke Golüke, M.D., Mirjam de Graaf, MSc, Engelina Groenewald, M.D., Renate Gross, M.D., Camilla Grube Segers, M.D., Renate Hadi, R.N., Qusai Ahmad Hasan Hamdan, BS, Bahaeddin Ben Hamida, MBBCh, Mohamed Hassan Hamza. M.D., Breanna Hetland, Ph.D., Jane Adele Hopkins, MHA, John Hopkins, MBChB, FRCPsych, Sarah Ahmed Atef Mohamed Ibrahim, MBBCH, Guglielmo Imbriaco RN MSN, on behalf of Aniarti, Italian Association of Critical Care Nurses, Azienda USL di Bologna Italy, Shigeaki Inoue, Ph.D., Arveen Jeyaseelan, M.D., Ali Jawad Kadhim, MBChB, Sabrina Kohler, MBBS FRACP, Rens Kooken, M.D., Anna St. Korompeli, Ph.D., Lars Krüger, MSc, Ayman Salim Abu Khutwah, Puck de Lange, M.D., Sharon Liefrink, R.N., Yu-min Lin, M.D., Shi Pei Loo, M.D., Sara Beatriz Lopes Rodrigues, M.D., Allan MacDonald, M.D., Gillian Madders, M.D., Claudia Massaro, M.D., Kerri Maya, MSL, Sofia Manioudaki, M.D., Natalie McAndrew, P.hD., Stewart McKenna, M.D., Isabel Maria Metelo Coimbra, M.D., Teresa Miranda, M.D., Mohamed Anwar Abdelsalam Mohamed, M.D., Mushin Mohammed Elhadi Agbna Mohammed, M.D., Malissa Mulkey, Ph.D., Fariha Naeem, M.D., Kensuke Nakamura, Ph.D., Mi-Ryeo Nam, Elaine Newman, MSc, Renae Nicol, CNC, Claire Noonan, Msc AP, Maria Inês Nunes Oliveira Lopes, M.D., Zina Otmani, Cynthia Olotu, M.D., Alice Margherita Ornago, M.D., Susan O’Reilly, MSc, Valerie Ozorio, M.D., Jessica Palakashappa, M.D., Tej Pandya, M.D., Panagiota Papadea, M.D., Metaxia Papanikolaou, M.D., Rose S. Penfold, MPH, Elena Pinardi, M.D., Inês Filipa Pinto Pereira, M.D., Chirantha Premathilaka, M.D., Monica Pop-Purceleanu, M.D., Marlene Puchegger, BSc, Nouralddeen Mohammed Qalhoud, M.D., Terence J. Quinn, M.D., Maike Raasing, Ph.D., Dalia Talaat Ragheb, M.D., Prasad Rajhans, M.D., Nuri Ramadan, M.D., Mushabbir Hossain Rubel, M.D., Kate Sainsbury, BSc, Francesco Salis, M.D., Florian Schimböck, MSc Med, Roman Schmädig, MSc, Yvonne Schoon, M.D., Deepak Sethia, M.D., Edith Sextl, MScN, Bhagyesh Shah, M.D., Dua’a Shaout, M.D., Alaa Fouad Sharabi, M.D., Lynn Shields, M.D., Kendall Smith, M.D., Linda Smulders-van Dam, MSc, Roy L Soiza, M.D., Andrea Spiegler, MSc, Lucy Stocks, MBBS, Stefan Sumerauer, MSc, Stephanie Tam, BSc, Aik Haw Tan, MBChB, FRACP, Suzanne Timmons, Ph.D., Peter Tohsche, MScN, Raquel Gouveia Torres, M.D., Chantal Toth, D.N.P., Vasiliki Tsolaki, Ph.D., Iben Tousgaard, MPH, Roberta Esteves Vieira de Castro, Birgit Vogt, M.D., Erica Walsh, M.D., Kristel Ward-Stockham, MANP, Melinda Webb-St. Mart, MPH, Franziska Wefer, MSc, Mariajne Elisabeth Wijnen-Meijer, Ph.D., Hilde Wøien, M.D., Inke Zastrow, MSc, Maria Beatrice Zazzara, M.D.</p></div></span></div> </div> </div> <a class="js-linked-footnotes" href="javascript:;">Author Notes</a> </div> </div> </div> <div class="pub-history-wrap clearfix js-history-dropdown-wrap"> <div class="pub-history-row clearfix"> <div class="ww-citation-primary"><em>Age and Ageing</em>, Volume 53, Issue 11, November 2024, afae248, <a href='https://doi.org/10.1093/ageing/afae248'>https://doi.org/10.1093/ageing/afae248</a></div> </div> <div class="pub-history-row clearfix"> <div class="ww-citation-date-wrap"> <div class="citation-label">Published:</div> <div class="citation-date">20 November 2024</div> </div> <a href="javascript:;" class="history-label js-history-dropdown-trigger st-article-history at-ArticleHistory"> <span>Article history</span><i class="icon-general-arrow-filled-down arrow-icon"></i> </a> </div> <div class="ww-history js-history-entries-wrap at-history-entries-wrap"> <div class="history-entry at-history-entry"> <div class="wi-state">Received:</div> <div class="wi-date">17 April 2024</div> </div> <div class="history-entry at-history-entry"> <div class="wi-state">Revision received:</div> <div class="wi-date">29 July 2024</div> </div> <div class="history-entry at-history-entry"> <div class="wi-state">Revision requested:</div> <div class="wi-date">13 August 2024</div> </div> <div class="history-entry at-history-entry"> <div class="wi-state">Published:</div> <div class="wi-date">20 November 2024</div> </div> </div> </div> </div> </div> <script> $(document).ready(function () { $('.article-top-widget').on('click', '.ati-toggle-trigger', function () { $(this).find('.icon-general-add, .icon-minus').toggleClass('icon-minus icon-general-add'); $(this).siblings('.ati-toggle-content').toggleClass('hide'); }); // In Chrome, an anchor tag with target="_blank" and a "mailto:" href opens a new tab/window as well as the email client // I suspect this behavior will be corrected in the future // Remove the target="_blank" $('ul.wi-affiliationList').find('a[href^="mailto:"]').each(function () { 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class="icon-menu_search js_expand-navsearch"><span class="screenreader-text">Search Menu</span></a></div> </div> </div> <input id="routename" name="RouteName" type="hidden" value="ageing" /> </div> </div> </div> </div> <div id="ContentTab" class="content active"> <div class="widget widget-ArticleFulltext widget-instance-OUP_Article_FullText_Widget"> <div class="module-widget"> <div class="widget-items" data-widgetname="ArticleFulltext"> <h2 scrollto-destination=494610715 id="494610715" class="abstract-title js-splitscreen-abstract-title" >Abstract</h2> <section class="abstract"><div class=" sec"><div class="title">Background</div><p class="chapter-para">Delirium, an acute brain dysfunction, is proposed to be highly prevalent in clinical care and shown to significantly increase the risk of mortality and dementia.</p></div><div class=" sec"><div class="title">Objectives</div><p class="chapter-para">To report on the global prevalence of clinically documented delirium and delirium-related clinical practices in wards caring for paediatric and adult patients in healthcare facilities.</p></div><div class=" sec"><div class="title">Design</div><p class="chapter-para">A prospective, cross-sectional, 39-question survey completed on World Delirium Awareness Day, 15 March 2023.</p></div><div class=" sec"><div class="title">Participants</div><p class="chapter-para">Clinicians or researchers with access to clinical data.</p></div><div class=" sec"><div class="title">Main Outcome and Measure</div><p class="chapter-para">The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. (4 h) and 8:00 p.m. (±4 h). Secondary outcomes included delirium-related care practices and barriers to use. Descriptive statistics were calculated and multilevel modelling was completed.</p></div><div class=" sec"><div class="title">Results</div><p class="chapter-para">1664 wards submitted surveys from 44 countries, reporting on delirium assessments at 8:00 a.m. (<em>n</em> = 36 048) and 8:00 p.m. (<em>n</em> = 32 867); 61% reported use of validated delirium assessment tools. At 8:00 a.m., 18% (<em>n</em> = 2788/15 458) and at 8:00 p.m., 17.7% (<em>n</em> = 2454/13 860) were delirium positive. Top prevention measures were pain management (86.7%), mobilisation (81.4%) and adequate fluids (80.4%). Frequently reported pharmacologic interventions were benzodiazepines (52.7%) and haloperidol (46.2%). Top barriers included the shortage of staff (54.3%), lack of time to educate staff (48.6%) and missing knowledge about delirium (38%).</p></div><div class=" sec"><div class="title">Conclusion and Relevance</div><p class="chapter-para">In this study, approximately one out of five patients were reported as delirious. The reported high use of benzodiazepines needs further evaluation as it is not aligned with best-practice recommendations. Findings provide a benchmark for future quality improvement projects and research.</p></div></section> <div class="article-metadata-panel clearfix at-ArticleMetadata"></div> <div class="kwd-group"><a class="kwd-part kwd-main" href="javascript:;" data-keyword=""global delirium prevalence"">global delirium prevalence</a>, <a class="kwd-part kwd-main" href="javascript:;" data-keyword=""standard of practice"">standard of practice</a>, <a class="kwd-part kwd-main" href="javascript:;" data-keyword=""delivery of health care"">delivery of health care</a>, <a class="kwd-part kwd-main" href="javascript:;" data-keyword=""cross-sectional studies"">cross-sectional studies</a>, <a class="kwd-part kwd-main" href="javascript:;" data-keyword=""older people"">older people</a></div> <h2 scrollto-destination=494610717 id="494610717" class="section-title js-splitscreen-section-title" data-legacy-id=sec10h>Key Points</h2> <ul class="bullet"><li><p class="chapter-para">The prevalence of delirium was 18% (<em>n</em> = 2788/15 458) at 8:00 a.m. and 17.7% (<em>n</em> = 2454/13 860) at 8:00 p.m.</p></li><li><p class="chapter-para">Prevalence of delirium varied significantly between continents, countries, age groups, discipline, ward and unit types.</p></li><li><p class="chapter-para">Pain management and use of benzodiazepines were the top reported non-pharmacologic and pharmacologic strategies, respectively.</p></li><li><p class="chapter-para">Best-practice recommendations for pharmacologic management of delirium were not followed (>50% reported benzodiazepine use).</p></li><li><p class="chapter-para">The study established a global framework and baseline of clinically documented delirium prevalence after the COVID-19 pandemic.</p></li><li><p class="chapter-para">In the companion article by Nydahl <em>et al</em>. (2024), wards/units that reported the use of a delirium management protocols were more likely to also report the use of validated delirium assessment tools.</p></li></ul> <h2 scrollto-destination=494610719 id="494610719" class="section-title js-splitscreen-section-title" data-legacy-id=sec11>Introduction</h2> <p class="chapter-para">Delirium is an acute physiologic disruption of brain networks supporting cognition and arousal, occurring in 10%–50% of hospitalised patients [<span class="xrefLink" id="jumplink-ref1 ref2 ref3"></span><a href="javascript:;" reveal-id="ref1 ref2 ref3" data-open="ref1 ref2 ref3" class="link link-ref link-reveal xref-bibr">1–3</a>]. Patients across the ageing spectrum are impacted by delirium with ageing adults, critically ill adults and paediatric patients shown to be at an increased risk [<span class="xrefLink" id="jumplink-ref1"></span><a href="javascript:;" reveal-id="ref1" data-open="ref1" class="link link-ref link-reveal xref-bibr">1</a>, <span class="xrefLink" id="jumplink-ref2"></span><a href="javascript:;" reveal-id="ref2" data-open="ref2" class="link link-ref link-reveal xref-bibr">2</a>, <span class="xrefLink" id="jumplink-ref4"></span><a href="javascript:;" reveal-id="ref4" data-open="ref4" class="link link-ref link-reveal xref-bibr">4</a>]. The occurrence of delirium has been significantly associated with an increased risk of mortality and dementia, and may lead to a myriad of downstream outcomes including institutionalisation, patient and family distress, anxiety, depression and functional decline [<span class="xrefLink" id="jumplink-ref1"></span><a href="javascript:;" reveal-id="ref1" data-open="ref1" class="link link-ref link-reveal xref-bibr">1</a>, <span class="xrefLink" id="jumplink-ref2"></span><a href="javascript:;" reveal-id="ref2" data-open="ref2" class="link link-ref link-reveal xref-bibr">2</a>, <span class="xrefLink" id="jumplink-ref5 ref6 ref7"></span><a href="javascript:;" reveal-id="ref5 ref6 ref7" data-open="ref5 ref6 ref7" class="link link-ref link-reveal xref-bibr">5–7</a>]. While evidence exists to detect, mitigate risk and prevent delirium, adoption of these tools and protocols into clinical practice has been arduous, particularly adherence to evidence-based actions, such as administration of routine delirium assessment tools.</p><p class="chapter-para">Over the past three decades, >20 delirium assessment tools were developed and validated across multiple patient populations and languages [<span class="xrefLink" id="jumplink-ref8 ref9 ref10"></span><a href="javascript:;" reveal-id="ref8 ref9 ref10" data-open="ref8 ref9 ref10" class="link link-ref link-reveal xref-bibr">8–10</a>]. Despite the availability of tools with high validity, reliability and availability, the adoption of routine delirium assessment into clinical practice has been marred by a mix of reasons, including knowledge deficits and resource availability [<span class="xrefLink" id="jumplink-ref11 ref12 ref13"></span><a href="javascript:;" reveal-id="ref11 ref12 ref13" data-open="ref11 ref12 ref13" class="link link-ref link-reveal xref-bibr">11–13</a>]. The current adoption of routine delirium assessment tool use is not known. To the authors’ knowledge, no studies have evaluated the prevalence of ‘invalid assessments’ in clinical care. Gaining insight into how often invalid methods, such as identification based on clinical impression, are used to assess for delirium in clinical care may provide valuable information for future implementation studies focused on improving the use of validated tools for delirium assessment. We sought to understand the current rate of routine delirium assessment in clinical practice across countries and patient populations.</p><p class="chapter-para">To begin to address this limitation, we developed and deployed an international 1-day point prevalence study on World Delirium Awareness Day (WDAD), 15 March 2023. Our primary objective was to report on the point prevalence of clinically documented delirium across countries and patient populations at two time points. Our secondary objective was to describe reported delirium assessment methods used, prevention and treatment protocols in use, and barriers to adoption in clinical practice.</p> <h2 scrollto-destination=494610723 id="494610723" class="section-title js-splitscreen-section-title" data-legacy-id=sec12>Methods</h2> <p class="chapter-para">This study follows a cross-sectional survey design. The principal investigators and co-investigators obtained Ethics and IRB approvals from their sites. Respondents consented to the study within the first survey section. The report of this study follows the Checklist for Reporting of Survey Studies (<span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499098&Signature=iLufYQjJXwClvbbOcF1ofm3DqfNG2GBb4YzYTk216tk7gStXFeI5GLzWahsFk5EIs3OVonq~HeLL~B776BnalJf1-ap4LID3Jrhi37-dW0kthSy-m0fSmUomc4qb2wpI1xShMegn-X3WdrHEtyENOzh6BqssY47WnyQHq3ZRhmJEAYO-lxmH3PewQ11HLKG5NkYmf4JRs4zDNz2Bq6r1mEynfYpzsI6MT4nIVuNEpRGuCQ3ZDYDboWithQDIXoN6ZWUgOTeyGqcsWFAxirKtniwUa2Cn2~-8BciDhU79K6M3aegMEuyBdWqYsO9EEESDtrh4Tf6jTMCwerGcxiQD1g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S1</a></span>).</p> <h3 scrollto-destination=494610725 id="494610725" class="section-title js-splitscreen-section-title" data-legacy-id=sec13>Sample characteristics</h3> <p class="chapter-para">The population studied was multilevel; healthcare facility, unit, clinician and clinically documented delirium assessment data (<span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499098&Signature=iLufYQjJXwClvbbOcF1ofm3DqfNG2GBb4YzYTk216tk7gStXFeI5GLzWahsFk5EIs3OVonq~HeLL~B776BnalJf1-ap4LID3Jrhi37-dW0kthSy-m0fSmUomc4qb2wpI1xShMegn-X3WdrHEtyENOzh6BqssY47WnyQHq3ZRhmJEAYO-lxmH3PewQ11HLKG5NkYmf4JRs4zDNz2Bq6r1mEynfYpzsI6MT4nIVuNEpRGuCQ3ZDYDboWithQDIXoN6ZWUgOTeyGqcsWFAxirKtniwUa2Cn2~-8BciDhU79K6M3aegMEuyBdWqYsO9EEESDtrh4Tf6jTMCwerGcxiQD1g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S2</a></span> further describes the levels and characteristics of collected data). Individuals working as a health care worker or representative in a health care setting were eligible to participate. Exclusion criteria were former patients, family members or clinicians working in an ambulatory care service or operation theatre/room. Snowball recruitment methods were used to recruit National Coordinators to the WDAD Study Team. National coordinators (<em>n</em> = 47) were defined as researchers or clinicians who volunteered to serve as a co-investigator for their country and/or institution and recruited local participants to assist with data collection.</p> <h3 scrollto-destination=494610727 id="494610727" class="section-title js-splitscreen-section-title" data-legacy-id=sec14>Data collection</h3> <p class="chapter-para">The survey was developed and pretested by an interprofessional team of clinicians and researchers (WDAD Study Team). The survey is composed of 14 sections (39 questions, 25 min to complete). The first three sections cover data protection, consent and security measures. The next 10 sections collected demographic data (survey respondent, hospital, reporting unit) and delirium-related information (primary outcome: clinically documented delirium; secondary outcomes: structures and processes, non-pharmacological and pharmacological treatments used, and barriers to addressing delirium).</p> <h3 scrollto-destination=494610729 id="494610729" class="section-title js-splitscreen-section-title" data-legacy-id=sec15>Primary outcome</h3> <p class="chapter-para">The primary outcome was the prevalence of clinically documented delirium at two time points (±4 h at both 8:00 a.m. and 8:00 p.m.). The survey requested information regarding the delirium assessment method used on each unit. Valid assessment tools were defined as measures recognised in the literature as reliable and validated tools [<span class="xrefLink" id="jumplink-ref9"></span><a href="javascript:;" reveal-id="ref9" data-open="ref9" class="link link-ref link-reveal xref-bibr">9</a>]. The delirium prevalence rate was analysed on reported valid assessments.</p> <h3 scrollto-destination=494610731 id="494610731" class="section-title js-splitscreen-section-title" data-legacy-id=sec16>Survey</h3> <p class="chapter-para">The survey was administered online using SurveyMonkey and was open for data entry on 14 March 2023 at 8:00 p.m. (CEST) and closed on 19 March, at 8:00 p.m. (CEST). Data entry for both time points of interest had to be completed in one survey. A security section was used to prevent duplicate entries. No patient-level protected health information data were collected, and no interventions or assessments were prospectively administered.</p> <h3 scrollto-destination=494610733 id="494610733" class="section-title js-splitscreen-section-title" data-legacy-id=sec17>Study preparation</h3> <p class="chapter-para">Virtual meetings (recorded) were held monthly for National Coordinators (October 2022–March 2023) to overview study progress, <span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499098&Signature=iLufYQjJXwClvbbOcF1ofm3DqfNG2GBb4YzYTk216tk7gStXFeI5GLzWahsFk5EIs3OVonq~HeLL~B776BnalJf1-ap4LID3Jrhi37-dW0kthSy-m0fSmUomc4qb2wpI1xShMegn-X3WdrHEtyENOzh6BqssY47WnyQHq3ZRhmJEAYO-lxmH3PewQ11HLKG5NkYmf4JRs4zDNz2Bq6r1mEynfYpzsI6MT4nIVuNEpRGuCQ3ZDYDboWithQDIXoN6ZWUgOTeyGqcsWFAxirKtniwUa2Cn2~-8BciDhU79K6M3aegMEuyBdWqYsO9EEESDtrh4Tf6jTMCwerGcxiQD1g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Fig. S1</a></span>. All study documents are available on the study site, <a class="link link-uri openInAnotherWindow" href="http://www.wdad-study.center/" target="_blank">wdad-study.center</a>. No additional incentives were offered. Further study details regarding consent, recruitment, survey development and study conduct are outlined in <span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499098&Signature=iLufYQjJXwClvbbOcF1ofm3DqfNG2GBb4YzYTk216tk7gStXFeI5GLzWahsFk5EIs3OVonq~HeLL~B776BnalJf1-ap4LID3Jrhi37-dW0kthSy-m0fSmUomc4qb2wpI1xShMegn-X3WdrHEtyENOzh6BqssY47WnyQHq3ZRhmJEAYO-lxmH3PewQ11HLKG5NkYmf4JRs4zDNz2Bq6r1mEynfYpzsI6MT4nIVuNEpRGuCQ3ZDYDboWithQDIXoN6ZWUgOTeyGqcsWFAxirKtniwUa2Cn2~-8BciDhU79K6M3aegMEuyBdWqYsO9EEESDtrh4Tf6jTMCwerGcxiQD1g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S3</a></span>.</p> <h3 scrollto-destination=494610735 id="494610735" class="section-title js-splitscreen-section-title" data-legacy-id=sec18>Statistical analysis</h3> <p class="chapter-para">Data quality control found that 84.4% (<em>n</em> = 1664/1972) of responses were complete based on the primary outcome. Of the excluded surveys, 94% (<em>n</em> = 290/308) of respondents did not proceed past the demographic section of the survey. No systematic patterns of missingness were identified and given there were non-normal distributions in most outcome variables, imputing the data would likely further introduce bias [<span class="xrefLink" id="jumplink-ref14"></span><a href="javascript:;" reveal-id="ref14" data-open="ref14" class="link link-ref link-reveal xref-bibr">14</a>]. Therefore, a complete case analysis was done [<span class="xrefLink" id="jumplink-ref15"></span><a href="javascript:;" reveal-id="ref15" data-open="ref15" class="link link-ref link-reveal xref-bibr">15</a>]. <span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499098&Signature=iLufYQjJXwClvbbOcF1ofm3DqfNG2GBb4YzYTk216tk7gStXFeI5GLzWahsFk5EIs3OVonq~HeLL~B776BnalJf1-ap4LID3Jrhi37-dW0kthSy-m0fSmUomc4qb2wpI1xShMegn-X3WdrHEtyENOzh6BqssY47WnyQHq3ZRhmJEAYO-lxmH3PewQ11HLKG5NkYmf4JRs4zDNz2Bq6r1mEynfYpzsI6MT4nIVuNEpRGuCQ3ZDYDboWithQDIXoN6ZWUgOTeyGqcsWFAxirKtniwUa2Cn2~-8BciDhU79K6M3aegMEuyBdWqYsO9EEESDtrh4Tf6jTMCwerGcxiQD1g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Figure S2</a></span> in the online supplement details excluded responses. <span class="xrefLink" id="jumplink-f1"></span><a href="javascript:;" data-modal-source-id="f1" class="link xref-fig">Figure 1</a> illustrates surveys completed per country and continent.</p> <a id="494610737" scrollto-destination="494610737"></a> <div data-id="f1" data-content-id="f1" class="fig fig-section js-fig-section" swap-content-for-modal="true"><div class="graphic-wrap"><img class="content-image" src="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/m_afae248f1.jpeg?Expires=1735499098&Signature=g23td-dg-F4xhyxfRylpLWq8u-lSMp0-zoJSUZ-mth~5TvEizrxU0FcwpRNL~3hiEYfNPHa4crhlSf3bhnHjTeUTvxRQUR1untZK6aoqvJy27pHkikuwjceKh0~XF3QCvpaKSUW7FsLntZV8VDFZT9m7XrEYTB9UqxqY8FBBlufyTaXCWuV18NbqvuhTHGz~1UnCt~Hk5mrlZ0HNmqAqleMrboGkYZeTvVRO4YEHIsncyvUG5aAUWF-aTheDWbfZoWs4FfGF1193JtKXyh-9xlq3gquIFnGWOMxD5xyU2QtUVANzxhsPU2ufXQMXobfgnz3t~O9ywOJmGlhzApA23w__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Surveys completed worldwide. Figure 1 illustrates the surveys completed per country and per continent. The numbers represent the total number of wards/units (bold) and total number of patients (in brackets). The grey-scale colour of the countries indicates the number of responses; a darker grey colour represents a high number of surveys received." data-path-from-xml="afae248f1.tif" /><div class="graphic-bottom"><div class="label fig-label" id="label-494610737">Figure 1</div><div class="caption fig-caption"><p class="chapter-para">Surveys completed worldwide. Figure 1 illustrates the surveys completed per country and per continent. The numbers represent the total number of wards/units (bold) and total number of patients (in brackets). The grey-scale colour of the countries indicates the number of responses; a darker grey colour represents a high number of surveys received.</p></div><div class="ajax-articleAbstract-exclude-regex fig-orig original-slide figure-button-wrap"><a class="fig-view-orig js-view-large at-figureViewLarge openInAnotherWindow" role="button" aria-describedby="label-494610737" href="/view-large/figure/494610737/afae248f1.tif" data-path-from-xml="afae248f1.tif" target="_blank">Open in new tab</a><a class="download-slide" role="button" aria-describedby="label-494610737" data-section="494610737" href="/DownloadFile/DownloadImage.aspx?image=https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/afae248f1.jpeg?Expires=1735499098&Signature=QXJPeiOTNAqTp4OqIJMTxpJ9jYmmGGTTisyBpbPqjVHGxh~hUGAUOY8GTkt3oHm46gSEZ0fG85fNfx~U8upyQdjbXppk3uUnLa1u6CHDz92zXKI4C2ymOycrkcyDbByiDJLllbHXu-4ItX36NQav9vJuPUY4JQ26l3ot3~F4DedVsvc-o44qIchOz19uKVP6VwndEyP8EFeFnHt17aBbS2R7NBfcVJ96TIBmyZn16IDapAidbWdUNEqyqUI7iGrd2HZ97kh8~CvX1YXbsArjyeUonbvIcNv9FGEk09JSXVQpgBfsVopUf-qs~rvUiqJFOtAc8DcTw0je9whFnPsemQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=494610737&ar=7905759&xsltPath=~/UI/app/XSLT&imagename=&siteId=5255" data-path-from-xml="afae248f1.tif">Download slide</a></div></div></div></div><p class="chapter-para">The analysis of nominal data is reported as absolute and relative frequencies (percentages), ordinal data in its modus. Due to non-normal distribution, metrical data are reported as medians and interquartile ranges (IQRs). Bivariate inferential tests were conducted using <em>F</em>-tests and Chi-squared tests, with a two-tailed <em>P</em> <.05. Given the exploratory nature of the study, no adjustment for multiple comparisons or confounding were made. Multilevel models were explored for the prevalence of clinically documented delirium at two time points. Models were evaluated for fit using log likelihood and Akaike’s Information Criterion (AIC). All analyses were conducted with SPSS version 23.0 (IBM SPSS Statistics for Windows, version 23.0; IBM Corp., Armonk, NY).</p> <h2 scrollto-destination=494610739 id="494610739" class="section-title js-splitscreen-section-title" data-legacy-id=sec19>Results</h2> <p class="chapter-para">In total, 1664 surveys representing 1664 wards/units were submitted across six continents (<em>n</em> = 44 countries) with aggregate datapoints from 36 048 patients at 8:00 p.m. and 32 867 patients at 8:00 p.m. on 15 March 2023. The rate of survey completion following completion of the consent form was 84.4%.</p><p class="chapter-para">Furthermore, 47.9% of the survey responders were nurses (<em>n</em> = 797/1664). Of these survey respondents, 39.5% (<em>n</em> = 658/1664) claimed responsibility for data acquisition and 28.9% (<em>n</em> = 481/1664) reported <5 years of experience on their unit (<span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499098&Signature=iLufYQjJXwClvbbOcF1ofm3DqfNG2GBb4YzYTk216tk7gStXFeI5GLzWahsFk5EIs3OVonq~HeLL~B776BnalJf1-ap4LID3Jrhi37-dW0kthSy-m0fSmUomc4qb2wpI1xShMegn-X3WdrHEtyENOzh6BqssY47WnyQHq3ZRhmJEAYO-lxmH3PewQ11HLKG5NkYmf4JRs4zDNz2Bq6r1mEynfYpzsI6MT4nIVuNEpRGuCQ3ZDYDboWithQDIXoN6ZWUgOTeyGqcsWFAxirKtniwUa2Cn2~-8BciDhU79K6M3aegMEuyBdWqYsO9EEESDtrh4Tf6jTMCwerGcxiQD1g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S4</a></span>).</p><p class="chapter-para">Forty-five percent of the reported wards/units were from university hospitals (44.7%, <em>n</em> = 744/1664) and 25.4% (<em>n</em> = 422/1664) reported <500 hospital beds. General wards/units represented 45.8% (<em>n</em> = 758/1664) and 36.2% (<em>n</em> = 603/1664) identified as medical/surgical disciplines. The median number of hospital beds per ward/unit was 22 (IQR 13–30) (<span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499098&Signature=iLufYQjJXwClvbbOcF1ofm3DqfNG2GBb4YzYTk216tk7gStXFeI5GLzWahsFk5EIs3OVonq~HeLL~B776BnalJf1-ap4LID3Jrhi37-dW0kthSy-m0fSmUomc4qb2wpI1xShMegn-X3WdrHEtyENOzh6BqssY47WnyQHq3ZRhmJEAYO-lxmH3PewQ11HLKG5NkYmf4JRs4zDNz2Bq6r1mEynfYpzsI6MT4nIVuNEpRGuCQ3ZDYDboWithQDIXoN6ZWUgOTeyGqcsWFAxirKtniwUa2Cn2~-8BciDhU79K6M3aegMEuyBdWqYsO9EEESDtrh4Tf6jTMCwerGcxiQD1g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S5</a></span>).</p> <h3 scrollto-destination=494610743 id="494610743" class="section-title js-splitscreen-section-title" data-legacy-id=sec20>Primary outcome: delirium prevalence</h3> <p class="chapter-para">Of the included patients, 70% (<em>n</em> = 25 268/36 048) were assessed for delirium at 8:00 a.m. and 69.6% (<em>n</em> = 22 862/32 867) were assessed for delirium at 8:00 p.m. Valid assessment tool use was reported in 61% (<em>n</em> = 15 458/25 268) of patients at 8:00 a.m., and 60.6% (<em>n</em> = 13 860/22 862) of patients at 8:00 p.m., resulting in a prevalence rate of 18% (<em>n</em> = 2788/15 458) and 17.7% (<em>n</em> = 2454/13 860), respectively. In wards/units using valid delirium assessment tools, the prevalence of delirium varied between continents, age groups, reported discipline of survey respondents and ward/unit types (all <em>P</em> < .001). <span class="xrefLink" id="jumplink-TB1"></span><a href="javascript:;" reveal-id="TB1" data-open="TB1" class="link link-reveal link-table xref-fig">Table 1</a> outlines all univariate results and characteristics.</p> <a id="494610745" scrollto-destination="494610745"></a> <div content-id="TB1" class="table-modal table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB1" data-id="TB1"><span class="label title-label" id="label-76790">Table 1</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/494610745" aria-describedby="label-76790"> Open in new tab </a></div><div class="caption caption-id-" id="caption-76790"><p class="chapter-para">Primary outcome. Prevalence of delirium using validated assessment tools</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-76790" aria-describedby="
 caption-76790"><thead><tr><th rowspan="2">Patients<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Morning 8 a.m.<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Evening 8:00 p.m.<span aria-hidden="true" style="display: none;"> . </span></th></tr><tr><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Overall</strong></td><td>15 458</td><td>2788 (18.0)</td><td>12 670 (82.0)</td><td></td><td>13 860</td><td>2454 (17.7)</td><td>11 406 (82.3)</td><td></td></tr><tr><td><strong>Continents</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Asia</td><td>1884</td><td>443 (23.5)</td><td>1441 (76.5)</td><td></td><td>1636</td><td>287 (17.5)</td><td>1349 (82.5)</td><td></td></tr><tr><td>Australia</td><td>2780</td><td>414 (14.9)</td><td>2366 (85.1)</td><td></td><td>2643</td><td>394 (14.9)</td><td>2249 (85.1)</td><td></td></tr><tr><td>Africa</td><td>1302</td><td>445 (34.2)</td><td>857 (65.8)</td><td></td><td>1177</td><td>415 (35.3)</td><td>762 (64.7)</td><td></td></tr><tr><td>Europe</td><td>7856</td><td>1202 (15.3)</td><td>6654 (84.7)</td><td></td><td>6883</td><td>1069 (15.5)</td><td>5814 (84.5)</td><td></td></tr><tr><td>S. America</td><td>144</td><td>37 (25.7)</td><td>107 (74.3)</td><td></td><td>134</td><td>33 (24.6)</td><td>101 (75.4)</td><td></td></tr><tr><td>N. America</td><td>1492</td><td>247 (16.6)</td><td>1245 (83.4)</td><td></td><td>1387</td><td>256 (18.5)</td><td>1131 (81.5)</td><td></td></tr><tr><td colspan="2"><strong>Age groups</strong></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>0–17 years</td><td>221</td><td>36 (16.3)</td><td>185 (83.7)</td><td></td><td>227</td><td>46 (20.3)</td><td>181 (79.7)</td><td></td></tr><tr><td>18–75 years</td><td>8390</td><td>1643 (19.6)</td><td>6747 (80.4)</td><td></td><td>7648</td><td>1427 (18.7)</td><td>6221 (81.3)</td><td></td></tr><tr><td>>75 years</td><td>3258</td><td>657 (19.2)</td><td>2633 (80.8)</td><td></td><td>2699</td><td>579 (21.5)</td><td>2120 (78.5)</td><td></td></tr><tr><td>Mixed</td><td>3586</td><td>484 (13.5)</td><td>3102 (86.5)</td><td></td><td>3282</td><td>402 (12.2)</td><td>2880 (87.8)</td><td></td></tr><tr><td><strong>Discipline</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Medical/non-surgical</td><td>5427</td><td>1049 (19.3)</td><td>4378 (80.7)</td><td></td><td>4915</td><td>926 (18.9)</td><td>3989 (81.1)</td><td></td></tr><tr><td>Surgical</td><td>3544</td><td>387 (10.9)</td><td>3157 (89.1)</td><td></td><td>3251</td><td>398 (12.2)</td><td>2853 (87.8)</td><td></td></tr><tr><td>Palliative</td><td>46</td><td>4 (8.7)</td><td>42 (91.3)</td><td></td><td>33</td><td>14 (42.4)</td><td>19 (57.6)</td><td></td></tr><tr><td>Respiratory/weaning</td><td>256</td><td>54 (21.1)</td><td>202 (78.9)</td><td></td><td>250</td><td>48 (19.2)</td><td>202 (80.8)</td><td></td></tr><tr><td>Rehabilitation</td><td>934</td><td>121 (13.0)</td><td>813 (87.0)</td><td></td><td>820</td><td>119 (14.5)</td><td>701 (85.5)</td><td></td></tr><tr><td>Long care</td><td>469</td><td>40 (8.5)</td><td>429 (91.5)</td><td></td><td>166</td><td>8 (4.8)</td><td>158 (95.2)</td><td></td></tr><tr><td>Mixed/general</td><td>4097</td><td>1025 (25.0)</td><td>3072 (75.0)</td><td></td><td>3847</td><td>861 (22.4)</td><td>2986 (77.6)</td><td></td></tr><tr><td>Other</td><td>677</td><td>106 (15.7)</td><td>571 (84.3)</td><td></td><td>570</td><td>78 (13.7)</td><td>492 (86.3)</td><td></td></tr><tr><td><strong>Ward/unit</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>ED</td><td>722</td><td>229 (31.7)</td><td>493 (68.3)</td><td></td><td>734</td><td>233 (31.7)</td><td>501 (68.3)</td><td></td></tr><tr><td>General ward</td><td>8269</td><td>1311 (15.9)</td><td>6958 (84.1)</td><td></td><td>7566</td><td>1176 (15.6)</td><td>6390 (84.4)</td><td></td></tr><tr><td>ICU, IMC, H.A.</td><td>4587</td><td>947 (20.6)</td><td>3640 (79.4)</td><td></td><td>4214</td><td>852 (20.2)</td><td>3362 (79.8)</td><td></td></tr><tr><td>Rehabilitation facility</td><td>833</td><td>115 (13.8)</td><td>718 (86.2)</td><td></td><td>774</td><td>121 (15.6)</td><td>653 (84.4)</td><td></td></tr><tr><td>Nursing home</td><td>447</td><td>53 (11.9)</td><td>394 (88.1)</td><td></td><td>128</td><td>5 (3.9)</td><td>123 (96.1)</td><td></td></tr><tr><td>Other</td><td>594</td><td>132 (22.2)</td><td>462 (77.8)</td><td></td><td>441</td><td>67 (15.2)</td><td>374 (84.8)</td><td></td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th rowspan="2">Patients<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Morning 8 a.m.<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Evening 8:00 p.m.<span aria-hidden="true" style="display: none;"> . </span></th></tr><tr><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Overall</strong></td><td>15 458</td><td>2788 (18.0)</td><td>12 670 (82.0)</td><td></td><td>13 860</td><td>2454 (17.7)</td><td>11 406 (82.3)</td><td></td></tr><tr><td><strong>Continents</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Asia</td><td>1884</td><td>443 (23.5)</td><td>1441 (76.5)</td><td></td><td>1636</td><td>287 (17.5)</td><td>1349 (82.5)</td><td></td></tr><tr><td>Australia</td><td>2780</td><td>414 (14.9)</td><td>2366 (85.1)</td><td></td><td>2643</td><td>394 (14.9)</td><td>2249 (85.1)</td><td></td></tr><tr><td>Africa</td><td>1302</td><td>445 (34.2)</td><td>857 (65.8)</td><td></td><td>1177</td><td>415 (35.3)</td><td>762 (64.7)</td><td></td></tr><tr><td>Europe</td><td>7856</td><td>1202 (15.3)</td><td>6654 (84.7)</td><td></td><td>6883</td><td>1069 (15.5)</td><td>5814 (84.5)</td><td></td></tr><tr><td>S. America</td><td>144</td><td>37 (25.7)</td><td>107 (74.3)</td><td></td><td>134</td><td>33 (24.6)</td><td>101 (75.4)</td><td></td></tr><tr><td>N. America</td><td>1492</td><td>247 (16.6)</td><td>1245 (83.4)</td><td></td><td>1387</td><td>256 (18.5)</td><td>1131 (81.5)</td><td></td></tr><tr><td colspan="2"><strong>Age groups</strong></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>0–17 years</td><td>221</td><td>36 (16.3)</td><td>185 (83.7)</td><td></td><td>227</td><td>46 (20.3)</td><td>181 (79.7)</td><td></td></tr><tr><td>18–75 years</td><td>8390</td><td>1643 (19.6)</td><td>6747 (80.4)</td><td></td><td>7648</td><td>1427 (18.7)</td><td>6221 (81.3)</td><td></td></tr><tr><td>>75 years</td><td>3258</td><td>657 (19.2)</td><td>2633 (80.8)</td><td></td><td>2699</td><td>579 (21.5)</td><td>2120 (78.5)</td><td></td></tr><tr><td>Mixed</td><td>3586</td><td>484 (13.5)</td><td>3102 (86.5)</td><td></td><td>3282</td><td>402 (12.2)</td><td>2880 (87.8)</td><td></td></tr><tr><td><strong>Discipline</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Medical/non-surgical</td><td>5427</td><td>1049 (19.3)</td><td>4378 (80.7)</td><td></td><td>4915</td><td>926 (18.9)</td><td>3989 (81.1)</td><td></td></tr><tr><td>Surgical</td><td>3544</td><td>387 (10.9)</td><td>3157 (89.1)</td><td></td><td>3251</td><td>398 (12.2)</td><td>2853 (87.8)</td><td></td></tr><tr><td>Palliative</td><td>46</td><td>4 (8.7)</td><td>42 (91.3)</td><td></td><td>33</td><td>14 (42.4)</td><td>19 (57.6)</td><td></td></tr><tr><td>Respiratory/weaning</td><td>256</td><td>54 (21.1)</td><td>202 (78.9)</td><td></td><td>250</td><td>48 (19.2)</td><td>202 (80.8)</td><td></td></tr><tr><td>Rehabilitation</td><td>934</td><td>121 (13.0)</td><td>813 (87.0)</td><td></td><td>820</td><td>119 (14.5)</td><td>701 (85.5)</td><td></td></tr><tr><td>Long care</td><td>469</td><td>40 (8.5)</td><td>429 (91.5)</td><td></td><td>166</td><td>8 (4.8)</td><td>158 (95.2)</td><td></td></tr><tr><td>Mixed/general</td><td>4097</td><td>1025 (25.0)</td><td>3072 (75.0)</td><td></td><td>3847</td><td>861 (22.4)</td><td>2986 (77.6)</td><td></td></tr><tr><td>Other</td><td>677</td><td>106 (15.7)</td><td>571 (84.3)</td><td></td><td>570</td><td>78 (13.7)</td><td>492 (86.3)</td><td></td></tr><tr><td><strong>Ward/unit</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>ED</td><td>722</td><td>229 (31.7)</td><td>493 (68.3)</td><td></td><td>734</td><td>233 (31.7)</td><td>501 (68.3)</td><td></td></tr><tr><td>General ward</td><td>8269</td><td>1311 (15.9)</td><td>6958 (84.1)</td><td></td><td>7566</td><td>1176 (15.6)</td><td>6390 (84.4)</td><td></td></tr><tr><td>ICU, IMC, H.A.</td><td>4587</td><td>947 (20.6)</td><td>3640 (79.4)</td><td></td><td>4214</td><td>852 (20.2)</td><td>3362 (79.8)</td><td></td></tr><tr><td>Rehabilitation facility</td><td>833</td><td>115 (13.8)</td><td>718 (86.2)</td><td></td><td>774</td><td>121 (15.6)</td><td>653 (84.4)</td><td></td></tr><tr><td>Nursing home</td><td>447</td><td>53 (11.9)</td><td>394 (88.1)</td><td></td><td>128</td><td>5 (3.9)</td><td>123 (96.1)</td><td></td></tr><tr><td>Other</td><td>594</td><td>132 (22.2)</td><td>462 (77.8)</td><td></td><td>441</td><td>67 (15.2)</td><td>374 (84.8)</td><td></td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para">The primary study outcome of documented delirium prevalence in clinical care in the morning (8:00 a.m. ± 4 h) and in the evening (8:00 p.m. ± 4 h) is summarised in <span class="xrefLink" id="jumplink-TB1"></span><a href="javascript:;" reveal-id="TB1" data-open="TB1" class="link link-reveal link-table xref-fig">Table 1</a> (aggregate data). The statistical results examining the differences between the time of the assessment, reported continents, age groups, discipline, ward or unit type are displayed. Due to the exploratory nature of the study, corrections for multiple comparisons or confounders were not made. ED, emergency department, H.A., high acuity; IMC, intermediate medical care; ICU, intensive care unit.</p></div></div></div><div class="table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB1" data-id="TB1"><span class="label title-label" id="label-76790">Table 1</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/494610745" aria-describedby="label-76790"> Open in new tab </a></div><div class="caption caption-id-" id="caption-76790"><p class="chapter-para">Primary outcome. Prevalence of delirium using validated assessment tools</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-76790" aria-describedby="
 caption-76790"><thead><tr><th rowspan="2">Patients<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Morning 8 a.m.<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Evening 8:00 p.m.<span aria-hidden="true" style="display: none;"> . </span></th></tr><tr><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Overall</strong></td><td>15 458</td><td>2788 (18.0)</td><td>12 670 (82.0)</td><td></td><td>13 860</td><td>2454 (17.7)</td><td>11 406 (82.3)</td><td></td></tr><tr><td><strong>Continents</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Asia</td><td>1884</td><td>443 (23.5)</td><td>1441 (76.5)</td><td></td><td>1636</td><td>287 (17.5)</td><td>1349 (82.5)</td><td></td></tr><tr><td>Australia</td><td>2780</td><td>414 (14.9)</td><td>2366 (85.1)</td><td></td><td>2643</td><td>394 (14.9)</td><td>2249 (85.1)</td><td></td></tr><tr><td>Africa</td><td>1302</td><td>445 (34.2)</td><td>857 (65.8)</td><td></td><td>1177</td><td>415 (35.3)</td><td>762 (64.7)</td><td></td></tr><tr><td>Europe</td><td>7856</td><td>1202 (15.3)</td><td>6654 (84.7)</td><td></td><td>6883</td><td>1069 (15.5)</td><td>5814 (84.5)</td><td></td></tr><tr><td>S. America</td><td>144</td><td>37 (25.7)</td><td>107 (74.3)</td><td></td><td>134</td><td>33 (24.6)</td><td>101 (75.4)</td><td></td></tr><tr><td>N. America</td><td>1492</td><td>247 (16.6)</td><td>1245 (83.4)</td><td></td><td>1387</td><td>256 (18.5)</td><td>1131 (81.5)</td><td></td></tr><tr><td colspan="2"><strong>Age groups</strong></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>0–17 years</td><td>221</td><td>36 (16.3)</td><td>185 (83.7)</td><td></td><td>227</td><td>46 (20.3)</td><td>181 (79.7)</td><td></td></tr><tr><td>18–75 years</td><td>8390</td><td>1643 (19.6)</td><td>6747 (80.4)</td><td></td><td>7648</td><td>1427 (18.7)</td><td>6221 (81.3)</td><td></td></tr><tr><td>>75 years</td><td>3258</td><td>657 (19.2)</td><td>2633 (80.8)</td><td></td><td>2699</td><td>579 (21.5)</td><td>2120 (78.5)</td><td></td></tr><tr><td>Mixed</td><td>3586</td><td>484 (13.5)</td><td>3102 (86.5)</td><td></td><td>3282</td><td>402 (12.2)</td><td>2880 (87.8)</td><td></td></tr><tr><td><strong>Discipline</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Medical/non-surgical</td><td>5427</td><td>1049 (19.3)</td><td>4378 (80.7)</td><td></td><td>4915</td><td>926 (18.9)</td><td>3989 (81.1)</td><td></td></tr><tr><td>Surgical</td><td>3544</td><td>387 (10.9)</td><td>3157 (89.1)</td><td></td><td>3251</td><td>398 (12.2)</td><td>2853 (87.8)</td><td></td></tr><tr><td>Palliative</td><td>46</td><td>4 (8.7)</td><td>42 (91.3)</td><td></td><td>33</td><td>14 (42.4)</td><td>19 (57.6)</td><td></td></tr><tr><td>Respiratory/weaning</td><td>256</td><td>54 (21.1)</td><td>202 (78.9)</td><td></td><td>250</td><td>48 (19.2)</td><td>202 (80.8)</td><td></td></tr><tr><td>Rehabilitation</td><td>934</td><td>121 (13.0)</td><td>813 (87.0)</td><td></td><td>820</td><td>119 (14.5)</td><td>701 (85.5)</td><td></td></tr><tr><td>Long care</td><td>469</td><td>40 (8.5)</td><td>429 (91.5)</td><td></td><td>166</td><td>8 (4.8)</td><td>158 (95.2)</td><td></td></tr><tr><td>Mixed/general</td><td>4097</td><td>1025 (25.0)</td><td>3072 (75.0)</td><td></td><td>3847</td><td>861 (22.4)</td><td>2986 (77.6)</td><td></td></tr><tr><td>Other</td><td>677</td><td>106 (15.7)</td><td>571 (84.3)</td><td></td><td>570</td><td>78 (13.7)</td><td>492 (86.3)</td><td></td></tr><tr><td><strong>Ward/unit</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>ED</td><td>722</td><td>229 (31.7)</td><td>493 (68.3)</td><td></td><td>734</td><td>233 (31.7)</td><td>501 (68.3)</td><td></td></tr><tr><td>General ward</td><td>8269</td><td>1311 (15.9)</td><td>6958 (84.1)</td><td></td><td>7566</td><td>1176 (15.6)</td><td>6390 (84.4)</td><td></td></tr><tr><td>ICU, IMC, H.A.</td><td>4587</td><td>947 (20.6)</td><td>3640 (79.4)</td><td></td><td>4214</td><td>852 (20.2)</td><td>3362 (79.8)</td><td></td></tr><tr><td>Rehabilitation facility</td><td>833</td><td>115 (13.8)</td><td>718 (86.2)</td><td></td><td>774</td><td>121 (15.6)</td><td>653 (84.4)</td><td></td></tr><tr><td>Nursing home</td><td>447</td><td>53 (11.9)</td><td>394 (88.1)</td><td></td><td>128</td><td>5 (3.9)</td><td>123 (96.1)</td><td></td></tr><tr><td>Other</td><td>594</td><td>132 (22.2)</td><td>462 (77.8)</td><td></td><td>441</td><td>67 (15.2)</td><td>374 (84.8)</td><td></td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th rowspan="2">Patients<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Morning 8 a.m.<span aria-hidden="true" style="display: none;"> . </span></th><th colspan="4">Evening 8:00 p.m.<span aria-hidden="true" style="display: none;"> . </span></th></tr><tr><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th><th>Total<span aria-hidden="true" style="display: none;"> . </span></th><th>Delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th>Non-delirious <em>N</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>P</em><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td><strong>Overall</strong></td><td>15 458</td><td>2788 (18.0)</td><td>12 670 (82.0)</td><td></td><td>13 860</td><td>2454 (17.7)</td><td>11 406 (82.3)</td><td></td></tr><tr><td><strong>Continents</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Asia</td><td>1884</td><td>443 (23.5)</td><td>1441 (76.5)</td><td></td><td>1636</td><td>287 (17.5)</td><td>1349 (82.5)</td><td></td></tr><tr><td>Australia</td><td>2780</td><td>414 (14.9)</td><td>2366 (85.1)</td><td></td><td>2643</td><td>394 (14.9)</td><td>2249 (85.1)</td><td></td></tr><tr><td>Africa</td><td>1302</td><td>445 (34.2)</td><td>857 (65.8)</td><td></td><td>1177</td><td>415 (35.3)</td><td>762 (64.7)</td><td></td></tr><tr><td>Europe</td><td>7856</td><td>1202 (15.3)</td><td>6654 (84.7)</td><td></td><td>6883</td><td>1069 (15.5)</td><td>5814 (84.5)</td><td></td></tr><tr><td>S. America</td><td>144</td><td>37 (25.7)</td><td>107 (74.3)</td><td></td><td>134</td><td>33 (24.6)</td><td>101 (75.4)</td><td></td></tr><tr><td>N. America</td><td>1492</td><td>247 (16.6)</td><td>1245 (83.4)</td><td></td><td>1387</td><td>256 (18.5)</td><td>1131 (81.5)</td><td></td></tr><tr><td colspan="2"><strong>Age groups</strong></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>0–17 years</td><td>221</td><td>36 (16.3)</td><td>185 (83.7)</td><td></td><td>227</td><td>46 (20.3)</td><td>181 (79.7)</td><td></td></tr><tr><td>18–75 years</td><td>8390</td><td>1643 (19.6)</td><td>6747 (80.4)</td><td></td><td>7648</td><td>1427 (18.7)</td><td>6221 (81.3)</td><td></td></tr><tr><td>>75 years</td><td>3258</td><td>657 (19.2)</td><td>2633 (80.8)</td><td></td><td>2699</td><td>579 (21.5)</td><td>2120 (78.5)</td><td></td></tr><tr><td>Mixed</td><td>3586</td><td>484 (13.5)</td><td>3102 (86.5)</td><td></td><td>3282</td><td>402 (12.2)</td><td>2880 (87.8)</td><td></td></tr><tr><td><strong>Discipline</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>Medical/non-surgical</td><td>5427</td><td>1049 (19.3)</td><td>4378 (80.7)</td><td></td><td>4915</td><td>926 (18.9)</td><td>3989 (81.1)</td><td></td></tr><tr><td>Surgical</td><td>3544</td><td>387 (10.9)</td><td>3157 (89.1)</td><td></td><td>3251</td><td>398 (12.2)</td><td>2853 (87.8)</td><td></td></tr><tr><td>Palliative</td><td>46</td><td>4 (8.7)</td><td>42 (91.3)</td><td></td><td>33</td><td>14 (42.4)</td><td>19 (57.6)</td><td></td></tr><tr><td>Respiratory/weaning</td><td>256</td><td>54 (21.1)</td><td>202 (78.9)</td><td></td><td>250</td><td>48 (19.2)</td><td>202 (80.8)</td><td></td></tr><tr><td>Rehabilitation</td><td>934</td><td>121 (13.0)</td><td>813 (87.0)</td><td></td><td>820</td><td>119 (14.5)</td><td>701 (85.5)</td><td></td></tr><tr><td>Long care</td><td>469</td><td>40 (8.5)</td><td>429 (91.5)</td><td></td><td>166</td><td>8 (4.8)</td><td>158 (95.2)</td><td></td></tr><tr><td>Mixed/general</td><td>4097</td><td>1025 (25.0)</td><td>3072 (75.0)</td><td></td><td>3847</td><td>861 (22.4)</td><td>2986 (77.6)</td><td></td></tr><tr><td>Other</td><td>677</td><td>106 (15.7)</td><td>571 (84.3)</td><td></td><td>570</td><td>78 (13.7)</td><td>492 (86.3)</td><td></td></tr><tr><td><strong>Ward/unit</strong></td><td></td><td></td><td></td><td><.001</td><td></td><td></td><td></td><td><.001</td></tr><tr><td>ED</td><td>722</td><td>229 (31.7)</td><td>493 (68.3)</td><td></td><td>734</td><td>233 (31.7)</td><td>501 (68.3)</td><td></td></tr><tr><td>General ward</td><td>8269</td><td>1311 (15.9)</td><td>6958 (84.1)</td><td></td><td>7566</td><td>1176 (15.6)</td><td>6390 (84.4)</td><td></td></tr><tr><td>ICU, IMC, H.A.</td><td>4587</td><td>947 (20.6)</td><td>3640 (79.4)</td><td></td><td>4214</td><td>852 (20.2)</td><td>3362 (79.8)</td><td></td></tr><tr><td>Rehabilitation facility</td><td>833</td><td>115 (13.8)</td><td>718 (86.2)</td><td></td><td>774</td><td>121 (15.6)</td><td>653 (84.4)</td><td></td></tr><tr><td>Nursing home</td><td>447</td><td>53 (11.9)</td><td>394 (88.1)</td><td></td><td>128</td><td>5 (3.9)</td><td>123 (96.1)</td><td></td></tr><tr><td>Other</td><td>594</td><td>132 (22.2)</td><td>462 (77.8)</td><td></td><td>441</td><td>67 (15.2)</td><td>374 (84.8)</td><td></td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para">The primary study outcome of documented delirium prevalence in clinical care in the morning (8:00 a.m. ± 4 h) and in the evening (8:00 p.m. ± 4 h) is summarised in <span class="xrefLink" id="jumplink-TB1"></span><a href="javascript:;" reveal-id="TB1" data-open="TB1" class="link link-reveal link-table xref-fig">Table 1</a> (aggregate data). The statistical results examining the differences between the time of the assessment, reported continents, age groups, discipline, ward or unit type are displayed. Due to the exploratory nature of the study, corrections for multiple comparisons or confounders were not made. ED, emergency department, H.A., high acuity; IMC, intermediate medical care; ICU, intensive care unit.</p></div></div></div><p class="chapter-para">The most frequently reported valid assessment tool was the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)-ICU (20.1%, <em>n</em> = 335/1664), followed by the 4AT (19.1%, <em>n</em> = 317/1664) and the Confusion Assessment Method (CAM) (9.0%, 150/1664) (<span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499099&Signature=jwIkxK-Oss0CDTQcbbb3tDqCZbX~kkNo85RnGTt4AJg4OWoOnYcttrO3qWgZ7oQPskwrOLOYZilky5754HDhdnCxuIhYoo204QI~ULtBsAhllVBJRvLitatrO4xticrJPI0onmnzwebuAJFXejWIxetUFqOM-IlPMooE5DnWh-6bn1ZlcQsNhN7ihfKVF9LrRYfbL-Kl09oHvAjbaBpBbR8acgmVll5leAiM2T43pR4O0SlTJWtxU8dJ4JzS7XOnP~2C7Z5-LnXpZcVwKqTUYIDGyBgO2asOhK0nqYRVq6uSi21BSWN-mIZ4gNINnCTFkxBlUQrcMpeV4261v8JH~A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S6</a></span>). Personal judgment was reported in 18.6% (<em>n</em> = 310/1664), 30.5% (<em>n</em> = 508/1664) reported assessing for delirium only in case of sudden changes of consciousness and 15.6% (<em>n</em> = 260/1664) reported assessing for delirium three times per day. Nurses were reported by 58.6% (<em>n</em> = 975/1664) as the profession primarily responsible for delirium assessment (<span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499099&Signature=jwIkxK-Oss0CDTQcbbb3tDqCZbX~kkNo85RnGTt4AJg4OWoOnYcttrO3qWgZ7oQPskwrOLOYZilky5754HDhdnCxuIhYoo204QI~ULtBsAhllVBJRvLitatrO4xticrJPI0onmnzwebuAJFXejWIxetUFqOM-IlPMooE5DnWh-6bn1ZlcQsNhN7ihfKVF9LrRYfbL-Kl09oHvAjbaBpBbR8acgmVll5leAiM2T43pR4O0SlTJWtxU8dJ4JzS7XOnP~2C7Z5-LnXpZcVwKqTUYIDGyBgO2asOhK0nqYRVq6uSi21BSWN-mIZ4gNINnCTFkxBlUQrcMpeV4261v8JH~A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S7</a></span>).</p> <h3 scrollto-destination=494610747 id="494610747" class="section-title js-splitscreen-section-title" data-legacy-id=sec21>Multilevel modelling</h3> <p class="chapter-para">Given the nested characteristics of the data, we fit a series of multilevel models to account for the clustering of observations at three levels (Level 1: hospitals, Level 2: countries, Level 3: continents) [<span class="xrefLink" id="jumplink-ref16"></span><a href="javascript:;" reveal-id="ref16" data-open="ref16" class="link link-ref link-reveal xref-bibr">16</a>]. The dependent variable (outcome) was the reported <em>n</em> (%) of clinically documented positive delirium assessments using validated tools at 8:00 a.m. and 8:00 p.m.</p> <h4 scrollto-destination=494610749 id="494610749" class="section-title js-splitscreen-section-title" data-legacy-id=sec22>8:00 a.m. Multilevel model</h4> <p class="chapter-para">At the hospital level, the number of reported beds (β = .032, Std error = .574, <em>t</em> = 2.225, <em>P</em> = .026), the reported average years of experience on the unit (β = 1.59, Std error = .319, <em>t</em> = 4.99, <em>P</em> < .001) and the patients’ age group (β = 1.28, Std error = .574, <em>t</em> = 2.225, <em>P</em> = .026) were all significantly related to the reported frequency of positive delirium assessments. Level 2 (country) was highly correlated with Level 3 (continent) and was omitted from the model. The continents were dichotomized into Europe (<em>n</em> = 629 wards/units) and others (<em>n</em> = 453 wards/units). Europe was significantly associated with reporting of 8:00 a.m. positive delirium assessments using validated tools (β = 6.23, Std error = 1.49, <em>t</em> = 4.17, <em>P</em> < .001). The final model explains 35% of the explainable variation in the point prevalence of clinically documented delirium across the globe at 8:00 a.m.</p> <h4 scrollto-destination=494610751 id="494610751" class="section-title js-splitscreen-section-title" data-legacy-id=sec23>8:00 p.m. Multilevel model</h4> <p class="chapter-para">At the hospital level, the number of reported beds was not significant (β = −.240, Std error = .455, <em>t</em> = −5.27, <em>P</em> = .598). The reported average years of experience (β = .770, Std error = .457, <em>t</em> = 2.68, <em>P</em> < .050) and the patients’ age group (β = −804, Std error = .830, <em>t</em> = −.968, <em>P</em> = .033) were significantly related to the reported frequency of positive delirium assessments. Europe remained associated with the reporting of the evening positive delirium assessment using validated tools (β = 6.046, Std error = 1.62, <em>t</em> = 3.73, <em>P</em> < .001). The final model explained 29% of the variation in the point prevalence of clinically documented delirium at 8:00 p.m. and had a 9% reduction in the deviance statistic (2LL = 8714–7930) and a 3.8% reduction in AIC (8359 to 8.042).</p> <h3 scrollto-destination=494610753 id="494610753" class="section-title js-splitscreen-section-title" data-legacy-id=sec24>Secondary outcomes: delirium management and barriers</h3> <p class="chapter-para">The most frequently reported written protocols included pain management (78.2%, <em>n</em> = 1301/1664), delirium management (65.7%, <em>n</em> = 1094/1664) and nutrition management (58.8%, <em>n</em> = 979/1664). Interventions to provide delirium awareness on the wards/units included delirium mentioned in handovers (59.7%, <em>n</em> = 994/1664), educational trainings (48.4%, <em>n</em> = 805/1664) and availability of delirium experts (30.1%, <em>n</em> = 501/1664) (<span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499099&Signature=jwIkxK-Oss0CDTQcbbb3tDqCZbX~kkNo85RnGTt4AJg4OWoOnYcttrO3qWgZ7oQPskwrOLOYZilky5754HDhdnCxuIhYoo204QI~ULtBsAhllVBJRvLitatrO4xticrJPI0onmnzwebuAJFXejWIxetUFqOM-IlPMooE5DnWh-6bn1ZlcQsNhN7ihfKVF9LrRYfbL-Kl09oHvAjbaBpBbR8acgmVll5leAiM2T43pR4O0SlTJWtxU8dJ4JzS7XOnP~2C7Z5-LnXpZcVwKqTUYIDGyBgO2asOhK0nqYRVq6uSi21BSWN-mIZ4gNINnCTFkxBlUQrcMpeV4261v8JH~A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S8</a></span>).</p><p class="chapter-para">The following routine non-pharmacological prevention and treatment interventions were reported as delivered at least once per shift, <span class="xrefLink" id="jumplink-TB2"></span><a href="javascript:;" reveal-id="TB2" data-open="TB2" class="link link-reveal link-table xref-fig">Table 2</a>: pain management (86.7%, <em>n</em> = 1443/1664), mobilisation (81.4%, <em>n</em> = 1354/1664) and adequate fluids (80.4%, <em>n</em> = 1338/1664). The use of physical restraints and sitters were reported in 24.6% (<em>n</em> = 409) and 22.8% (<em>n</em> = 380), respectively.</p> <a id="494610756" scrollto-destination="494610756"></a> <div content-id="TB2" class="table-modal table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB2" data-id="TB2"><span class="label title-label" id="label-12670">Table 2</span><div class="
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 /view-large/494610756" aria-describedby="label-12670"> Open in new tab </a></div><div class="caption caption-id-" id="caption-12670"><p class="chapter-para">Non-pharmacological delirium prevention and therapy</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-12670" aria-describedby="
 caption-12670"><thead><tr><th>Routine non-pharmacological interventions, <em>n</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn1"></span><a href="javascript:;" reveal-id="tblfn1" data-open="tblfn1" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Pain management</td><td>1443 (86.7)</td></tr><tr><td>Mobilisation (i.e. sitting on the edge of the bed or more, daytime)</td><td>1354 (81.4)</td></tr><tr><td>Adequate fluids</td><td>1338 (80.4)</td></tr><tr><td>Verbal re-orientation</td><td>1137 (68.3)</td></tr><tr><td>Provision glasses, hearing, mobility aids</td><td>1045 (62.8)</td></tr><tr><td>Cognitive stimulation (i.e. provision of newspapers, TV, music, other)</td><td>1005 (60.4)</td></tr><tr><td>Open or liberal visiting times for families (daytime)</td><td>969 (58.2)</td></tr><tr><td>Provision day and night rhythm</td><td>920 (55.3)</td></tr><tr><td>Family information</td><td>898 (54.0)</td></tr><tr><td>Non-disturbed sleep (i.e. reduction of noise and light)</td><td>856 (51.4)</td></tr><tr><td>Family engagement</td><td>795 (47.8)</td></tr><tr><td>Multiprofessional team rounds</td><td>782 (47.0)</td></tr><tr><td>Avoidance bladder tubes/catheters</td><td>679 (40.8)</td></tr><tr><td>Bed boarders</td><td>675 (40.6)</td></tr><tr><td>Informing patients about delirium</td><td>595 (35.8)</td></tr><tr><td>Multiprofessional daily goals</td><td>520 (31.8)</td></tr><tr><td>Physical restraints (i.e. on wrists or others)</td><td>409 (24.6)</td></tr><tr><td>Sitter (besides the patient for longer time, mostly over hours)</td><td>380 (22.8)</td></tr><tr><td>Ear plugs, sleep glasses</td><td>319 (29.2)</td></tr><tr><td>Ground-levelled beds</td><td>307 (18.4)</td></tr><tr><td>Going outside the unit or ward (i.e. hospital hall, garden, sunlight)</td><td>269 (16.2)</td></tr><tr><td>Special trained experts</td><td>174 (10.5)</td></tr><tr><td>Activities in patient groups (i.e. singing, eating, doing exercises, other)</td><td>133 (8.0)</td></tr><tr><td>Animal-assisted therapy</td><td>69 (4.1)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th>Routine non-pharmacological interventions, <em>n</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn1"></span><a href="javascript:;" reveal-id="tblfn1" data-open="tblfn1" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Pain management</td><td>1443 (86.7)</td></tr><tr><td>Mobilisation (i.e. sitting on the edge of the bed or more, daytime)</td><td>1354 (81.4)</td></tr><tr><td>Adequate fluids</td><td>1338 (80.4)</td></tr><tr><td>Verbal re-orientation</td><td>1137 (68.3)</td></tr><tr><td>Provision glasses, hearing, mobility aids</td><td>1045 (62.8)</td></tr><tr><td>Cognitive stimulation (i.e. provision of newspapers, TV, music, other)</td><td>1005 (60.4)</td></tr><tr><td>Open or liberal visiting times for families (daytime)</td><td>969 (58.2)</td></tr><tr><td>Provision day and night rhythm</td><td>920 (55.3)</td></tr><tr><td>Family information</td><td>898 (54.0)</td></tr><tr><td>Non-disturbed sleep (i.e. reduction of noise and light)</td><td>856 (51.4)</td></tr><tr><td>Family engagement</td><td>795 (47.8)</td></tr><tr><td>Multiprofessional team rounds</td><td>782 (47.0)</td></tr><tr><td>Avoidance bladder tubes/catheters</td><td>679 (40.8)</td></tr><tr><td>Bed boarders</td><td>675 (40.6)</td></tr><tr><td>Informing patients about delirium</td><td>595 (35.8)</td></tr><tr><td>Multiprofessional daily goals</td><td>520 (31.8)</td></tr><tr><td>Physical restraints (i.e. on wrists or others)</td><td>409 (24.6)</td></tr><tr><td>Sitter (besides the patient for longer time, mostly over hours)</td><td>380 (22.8)</td></tr><tr><td>Ear plugs, sleep glasses</td><td>319 (29.2)</td></tr><tr><td>Ground-levelled beds</td><td>307 (18.4)</td></tr><tr><td>Going outside the unit or ward (i.e. hospital hall, garden, sunlight)</td><td>269 (16.2)</td></tr><tr><td>Special trained experts</td><td>174 (10.5)</td></tr><tr><td>Activities in patient groups (i.e. singing, eating, doing exercises, other)</td><td>133 (8.0)</td></tr><tr><td>Animal-assisted therapy</td><td>69 (4.1)</td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para"><span class="xrefLink" id="jumplink-TB2"></span><a href="javascript:;" reveal-id="TB2" data-open="TB2" class="link link-reveal link-table xref-fig">Table 2</a> describes survey responses to the question ‘Do most patients (≥50%) on your unit or ward receive routine non-pharmacological interventions (at least once per shift) for delirium prevention and treatment? (Check all that apply)’.</p><span id="fn-tblfn1"></span><div content-id="tblfn1" class="footnote"><span class="fn"><p class="chapter-para"><sup>a</sup>Multiple responses, total percent >100%.</p></span></div></div></div></div><div class="table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB2" data-id="TB2"><span class="label title-label" id="label-12670">Table 2</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/494610756" aria-describedby="label-12670"> Open in new tab </a></div><div class="caption caption-id-" id="caption-12670"><p class="chapter-para">Non-pharmacological delirium prevention and therapy</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-12670" aria-describedby="
 caption-12670"><thead><tr><th>Routine non-pharmacological interventions, <em>n</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn1"></span><a href="javascript:;" reveal-id="tblfn1" data-open="tblfn1" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Pain management</td><td>1443 (86.7)</td></tr><tr><td>Mobilisation (i.e. sitting on the edge of the bed or more, daytime)</td><td>1354 (81.4)</td></tr><tr><td>Adequate fluids</td><td>1338 (80.4)</td></tr><tr><td>Verbal re-orientation</td><td>1137 (68.3)</td></tr><tr><td>Provision glasses, hearing, mobility aids</td><td>1045 (62.8)</td></tr><tr><td>Cognitive stimulation (i.e. provision of newspapers, TV, music, other)</td><td>1005 (60.4)</td></tr><tr><td>Open or liberal visiting times for families (daytime)</td><td>969 (58.2)</td></tr><tr><td>Provision day and night rhythm</td><td>920 (55.3)</td></tr><tr><td>Family information</td><td>898 (54.0)</td></tr><tr><td>Non-disturbed sleep (i.e. reduction of noise and light)</td><td>856 (51.4)</td></tr><tr><td>Family engagement</td><td>795 (47.8)</td></tr><tr><td>Multiprofessional team rounds</td><td>782 (47.0)</td></tr><tr><td>Avoidance bladder tubes/catheters</td><td>679 (40.8)</td></tr><tr><td>Bed boarders</td><td>675 (40.6)</td></tr><tr><td>Informing patients about delirium</td><td>595 (35.8)</td></tr><tr><td>Multiprofessional daily goals</td><td>520 (31.8)</td></tr><tr><td>Physical restraints (i.e. on wrists or others)</td><td>409 (24.6)</td></tr><tr><td>Sitter (besides the patient for longer time, mostly over hours)</td><td>380 (22.8)</td></tr><tr><td>Ear plugs, sleep glasses</td><td>319 (29.2)</td></tr><tr><td>Ground-levelled beds</td><td>307 (18.4)</td></tr><tr><td>Going outside the unit or ward (i.e. hospital hall, garden, sunlight)</td><td>269 (16.2)</td></tr><tr><td>Special trained experts</td><td>174 (10.5)</td></tr><tr><td>Activities in patient groups (i.e. singing, eating, doing exercises, other)</td><td>133 (8.0)</td></tr><tr><td>Animal-assisted therapy</td><td>69 (4.1)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th>Routine non-pharmacological interventions, <em>n</em> (%)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn1"></span><a href="javascript:;" reveal-id="tblfn1" data-open="tblfn1" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Pain management</td><td>1443 (86.7)</td></tr><tr><td>Mobilisation (i.e. sitting on the edge of the bed or more, daytime)</td><td>1354 (81.4)</td></tr><tr><td>Adequate fluids</td><td>1338 (80.4)</td></tr><tr><td>Verbal re-orientation</td><td>1137 (68.3)</td></tr><tr><td>Provision glasses, hearing, mobility aids</td><td>1045 (62.8)</td></tr><tr><td>Cognitive stimulation (i.e. provision of newspapers, TV, music, other)</td><td>1005 (60.4)</td></tr><tr><td>Open or liberal visiting times for families (daytime)</td><td>969 (58.2)</td></tr><tr><td>Provision day and night rhythm</td><td>920 (55.3)</td></tr><tr><td>Family information</td><td>898 (54.0)</td></tr><tr><td>Non-disturbed sleep (i.e. reduction of noise and light)</td><td>856 (51.4)</td></tr><tr><td>Family engagement</td><td>795 (47.8)</td></tr><tr><td>Multiprofessional team rounds</td><td>782 (47.0)</td></tr><tr><td>Avoidance bladder tubes/catheters</td><td>679 (40.8)</td></tr><tr><td>Bed boarders</td><td>675 (40.6)</td></tr><tr><td>Informing patients about delirium</td><td>595 (35.8)</td></tr><tr><td>Multiprofessional daily goals</td><td>520 (31.8)</td></tr><tr><td>Physical restraints (i.e. on wrists or others)</td><td>409 (24.6)</td></tr><tr><td>Sitter (besides the patient for longer time, mostly over hours)</td><td>380 (22.8)</td></tr><tr><td>Ear plugs, sleep glasses</td><td>319 (29.2)</td></tr><tr><td>Ground-levelled beds</td><td>307 (18.4)</td></tr><tr><td>Going outside the unit or ward (i.e. hospital hall, garden, sunlight)</td><td>269 (16.2)</td></tr><tr><td>Special trained experts</td><td>174 (10.5)</td></tr><tr><td>Activities in patient groups (i.e. singing, eating, doing exercises, other)</td><td>133 (8.0)</td></tr><tr><td>Animal-assisted therapy</td><td>69 (4.1)</td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para"><span class="xrefLink" id="jumplink-TB2"></span><a href="javascript:;" reveal-id="TB2" data-open="TB2" class="link link-reveal link-table xref-fig">Table 2</a> describes survey responses to the question ‘Do most patients (≥50%) on your unit or ward receive routine non-pharmacological interventions (at least once per shift) for delirium prevention and treatment? (Check all that apply)’.</p><span id="fn-tblfn1"></span><div content-id="tblfn1" class="footnote"><span class="fn"><p class="chapter-para"><sup>a</sup>Multiple responses, total percent >100%.</p></span></div></div></div></div><p class="chapter-para">The top three pharmacological interventions were reported as benzodiazepines (52.7%, <em>n</em> = 877/1664), haloperidol (46.2%, <em>n</em> = 768/1664) and quetiapine (38.4%, <em>n</em> = 639/1664), <span class="xrefLink" id="jumplink-TB3"></span><a href="javascript:;" reveal-id="TB3" data-open="TB3" class="link link-reveal link-table xref-fig">Table 3</a>. The reduction of delirogenic medications was reported as a pharmacological intervention in 30% (<em>n</em> = 500/1664) of wards/units. Fifty-eight percent reported that pharmacological management depended on specific symptoms (58.7%, <em>n</em> = 977/1664). One-third of respondents (34%, <em>n</em> = 566/1664) report providing recommendations for withdrawal of delirium-related drugs.</p> <a id="494610758" scrollto-destination="494610758"></a> <div content-id="TB3" class="table-modal table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB3" data-id="TB3"><span class="label title-label" id="label-12670">Table 3</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/494610758" aria-describedby="label-12670"> Open in new tab </a></div><div class="caption caption-id-" id="caption-12670"><p class="chapter-para">Reported pharmacological management of delirium</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-12670" aria-describedby="
 caption-12670"><thead><tr><th>Majority (>50%) of patients with delirium receive …<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Haloperidol</td><td>768 (46.2)</td></tr><tr><td>Quetiapine</td><td>639 (38.4)</td></tr><tr><td>Reducing of delirogenic drugs</td><td>500 (30.0)</td></tr><tr><td>Evaluation by a specialist</td><td>439 (26.4)</td></tr><tr><td>Lorazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>424 (25.5)</td></tr><tr><td>Dexmedetomidine</td><td>401 (24.1)</td></tr><tr><td>Risperidone</td><td>372 (22.4)</td></tr><tr><td>Melatonin</td><td>268 (16.1)</td></tr><tr><td>Clonidine</td><td>250 (15.0)</td></tr><tr><td>Midazolam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>231 (13.9)</td></tr><tr><td>Diazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>222 (13.3)</td></tr><tr><td>Beta-Blockers</td><td>102 (6.1)</td></tr><tr><td>Melperone</td><td>96 (5.8)</td></tr><tr><td>Levodopa</td><td>35 (2.1)</td></tr><tr><td>Phenobarbital</td><td>34 (2.0)</td></tr><tr><td>Distraneurin</td><td>19 (1.1)</td></tr><tr><td>I do not know</td><td>129 (7.8)</td></tr><tr><td>Missing data</td><td>170 (10.2)</td></tr><tr><td colspan="2"><strong>Pharmacological management …</strong></td></tr><tr><td>Depends on specific symptoms of each patient’s delirium</td><td>977 (58.7)</td></tr><tr><td>Is a more individual approach, depending on patients, and side effects</td><td>913 (54.9)</td></tr><tr><td>Is reported in handovers</td><td>852 (51.2)</td></tr><tr><td>Is discussed with families in most cases</td><td>574 (34.5)</td></tr><tr><td>Includes recommendations for withdrawal of delirium-related drugs</td><td>566 (34.0)</td></tr><tr><td>Is based on a standard operation procedure/protocol</td><td>501 (30.1)</td></tr><tr><td>Includes psychiatrist or delirium specific liaison team</td><td>454 (27.3)</td></tr><tr><td>Is a more general approach, including a few pharmacological agents</td><td>396 (23.8)</td></tr><tr><td>Includes pharmacologists</td><td>342 (20.6)</td></tr><tr><td>Is discussed with patients in most cases</td><td>310 (18.6)</td></tr><tr><td>None of the above</td><td>50 (3.0)</td></tr><tr><td>Missing data</td><td>67 (4.0)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th>Majority (>50%) of patients with delirium receive …<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Haloperidol</td><td>768 (46.2)</td></tr><tr><td>Quetiapine</td><td>639 (38.4)</td></tr><tr><td>Reducing of delirogenic drugs</td><td>500 (30.0)</td></tr><tr><td>Evaluation by a specialist</td><td>439 (26.4)</td></tr><tr><td>Lorazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>424 (25.5)</td></tr><tr><td>Dexmedetomidine</td><td>401 (24.1)</td></tr><tr><td>Risperidone</td><td>372 (22.4)</td></tr><tr><td>Melatonin</td><td>268 (16.1)</td></tr><tr><td>Clonidine</td><td>250 (15.0)</td></tr><tr><td>Midazolam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>231 (13.9)</td></tr><tr><td>Diazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>222 (13.3)</td></tr><tr><td>Beta-Blockers</td><td>102 (6.1)</td></tr><tr><td>Melperone</td><td>96 (5.8)</td></tr><tr><td>Levodopa</td><td>35 (2.1)</td></tr><tr><td>Phenobarbital</td><td>34 (2.0)</td></tr><tr><td>Distraneurin</td><td>19 (1.1)</td></tr><tr><td>I do not know</td><td>129 (7.8)</td></tr><tr><td>Missing data</td><td>170 (10.2)</td></tr><tr><td colspan="2"><strong>Pharmacological management …</strong></td></tr><tr><td>Depends on specific symptoms of each patient’s delirium</td><td>977 (58.7)</td></tr><tr><td>Is a more individual approach, depending on patients, and side effects</td><td>913 (54.9)</td></tr><tr><td>Is reported in handovers</td><td>852 (51.2)</td></tr><tr><td>Is discussed with families in most cases</td><td>574 (34.5)</td></tr><tr><td>Includes recommendations for withdrawal of delirium-related drugs</td><td>566 (34.0)</td></tr><tr><td>Is based on a standard operation procedure/protocol</td><td>501 (30.1)</td></tr><tr><td>Includes psychiatrist or delirium specific liaison team</td><td>454 (27.3)</td></tr><tr><td>Is a more general approach, including a few pharmacological agents</td><td>396 (23.8)</td></tr><tr><td>Includes pharmacologists</td><td>342 (20.6)</td></tr><tr><td>Is discussed with patients in most cases</td><td>310 (18.6)</td></tr><tr><td>None of the above</td><td>50 (3.0)</td></tr><tr><td>Missing data</td><td>67 (4.0)</td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para">This table describes the survey responses received to following questions:</p><p class="chapter-para">(1) Do most delirious patients (≥50%) of your unit or ward receive pharmacological interventions (click all that apply)?</p><p class="chapter-para">(2) In general, the pharmacological management on my unit or ward in delirium … (click all that apply).</p><span id="fn-tblfn2"></span><div content-id="tblfn2" class="footnote"><span class="fn"><p class="chapter-para"><sup>a</sup>Indicates a benzodiazepine. When combined (lorazepam, midazolam and diazepam), benzodiazepines are the leading pharmacological measure reported.</p></span></div></div></div></div><div class="table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB3" data-id="TB3"><span class="label title-label" id="label-12670">Table 3</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/494610758" aria-describedby="label-12670"> Open in new tab </a></div><div class="caption caption-id-" id="caption-12670"><p class="chapter-para">Reported pharmacological management of delirium</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-12670" aria-describedby="
 caption-12670"><thead><tr><th>Majority (>50%) of patients with delirium receive …<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Haloperidol</td><td>768 (46.2)</td></tr><tr><td>Quetiapine</td><td>639 (38.4)</td></tr><tr><td>Reducing of delirogenic drugs</td><td>500 (30.0)</td></tr><tr><td>Evaluation by a specialist</td><td>439 (26.4)</td></tr><tr><td>Lorazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>424 (25.5)</td></tr><tr><td>Dexmedetomidine</td><td>401 (24.1)</td></tr><tr><td>Risperidone</td><td>372 (22.4)</td></tr><tr><td>Melatonin</td><td>268 (16.1)</td></tr><tr><td>Clonidine</td><td>250 (15.0)</td></tr><tr><td>Midazolam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>231 (13.9)</td></tr><tr><td>Diazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>222 (13.3)</td></tr><tr><td>Beta-Blockers</td><td>102 (6.1)</td></tr><tr><td>Melperone</td><td>96 (5.8)</td></tr><tr><td>Levodopa</td><td>35 (2.1)</td></tr><tr><td>Phenobarbital</td><td>34 (2.0)</td></tr><tr><td>Distraneurin</td><td>19 (1.1)</td></tr><tr><td>I do not know</td><td>129 (7.8)</td></tr><tr><td>Missing data</td><td>170 (10.2)</td></tr><tr><td colspan="2"><strong>Pharmacological management …</strong></td></tr><tr><td>Depends on specific symptoms of each patient’s delirium</td><td>977 (58.7)</td></tr><tr><td>Is a more individual approach, depending on patients, and side effects</td><td>913 (54.9)</td></tr><tr><td>Is reported in handovers</td><td>852 (51.2)</td></tr><tr><td>Is discussed with families in most cases</td><td>574 (34.5)</td></tr><tr><td>Includes recommendations for withdrawal of delirium-related drugs</td><td>566 (34.0)</td></tr><tr><td>Is based on a standard operation procedure/protocol</td><td>501 (30.1)</td></tr><tr><td>Includes psychiatrist or delirium specific liaison team</td><td>454 (27.3)</td></tr><tr><td>Is a more general approach, including a few pharmacological agents</td><td>396 (23.8)</td></tr><tr><td>Includes pharmacologists</td><td>342 (20.6)</td></tr><tr><td>Is discussed with patients in most cases</td><td>310 (18.6)</td></tr><tr><td>None of the above</td><td>50 (3.0)</td></tr><tr><td>Missing data</td><td>67 (4.0)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th>Majority (>50%) of patients with delirium receive …<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Haloperidol</td><td>768 (46.2)</td></tr><tr><td>Quetiapine</td><td>639 (38.4)</td></tr><tr><td>Reducing of delirogenic drugs</td><td>500 (30.0)</td></tr><tr><td>Evaluation by a specialist</td><td>439 (26.4)</td></tr><tr><td>Lorazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>424 (25.5)</td></tr><tr><td>Dexmedetomidine</td><td>401 (24.1)</td></tr><tr><td>Risperidone</td><td>372 (22.4)</td></tr><tr><td>Melatonin</td><td>268 (16.1)</td></tr><tr><td>Clonidine</td><td>250 (15.0)</td></tr><tr><td>Midazolam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>231 (13.9)</td></tr><tr><td>Diazepam<span class="xrefLink" id="jumplink-tblfn2"></span><a href="javascript:;" reveal-id="tblfn2" data-open="tblfn2" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a></td><td>222 (13.3)</td></tr><tr><td>Beta-Blockers</td><td>102 (6.1)</td></tr><tr><td>Melperone</td><td>96 (5.8)</td></tr><tr><td>Levodopa</td><td>35 (2.1)</td></tr><tr><td>Phenobarbital</td><td>34 (2.0)</td></tr><tr><td>Distraneurin</td><td>19 (1.1)</td></tr><tr><td>I do not know</td><td>129 (7.8)</td></tr><tr><td>Missing data</td><td>170 (10.2)</td></tr><tr><td colspan="2"><strong>Pharmacological management …</strong></td></tr><tr><td>Depends on specific symptoms of each patient’s delirium</td><td>977 (58.7)</td></tr><tr><td>Is a more individual approach, depending on patients, and side effects</td><td>913 (54.9)</td></tr><tr><td>Is reported in handovers</td><td>852 (51.2)</td></tr><tr><td>Is discussed with families in most cases</td><td>574 (34.5)</td></tr><tr><td>Includes recommendations for withdrawal of delirium-related drugs</td><td>566 (34.0)</td></tr><tr><td>Is based on a standard operation procedure/protocol</td><td>501 (30.1)</td></tr><tr><td>Includes psychiatrist or delirium specific liaison team</td><td>454 (27.3)</td></tr><tr><td>Is a more general approach, including a few pharmacological agents</td><td>396 (23.8)</td></tr><tr><td>Includes pharmacologists</td><td>342 (20.6)</td></tr><tr><td>Is discussed with patients in most cases</td><td>310 (18.6)</td></tr><tr><td>None of the above</td><td>50 (3.0)</td></tr><tr><td>Missing data</td><td>67 (4.0)</td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para">This table describes the survey responses received to following questions:</p><p class="chapter-para">(1) Do most delirious patients (≥50%) of your unit or ward receive pharmacological interventions (click all that apply)?</p><p class="chapter-para">(2) In general, the pharmacological management on my unit or ward in delirium … (click all that apply).</p><span id="fn-tblfn2"></span><div content-id="tblfn2" class="footnote"><span class="fn"><p class="chapter-para"><sup>a</sup>Indicates a benzodiazepine. When combined (lorazepam, midazolam and diazepam), benzodiazepines are the leading pharmacological measure reported.</p></span></div></div></div></div><p class="chapter-para">The top three reported barriers to implementation and/or use of evidence-based strategies in delirium assessment and management were staff shortages (54.3%, <em>n</em> = 903/1664), lack of time to educate staff (48.6%, <em>n</em> = 809/1664) and missing knowledge about delirium (38%, <em>n</em> = 632/1664) (<span class="xrefLink" id="jumplink-TB4"></span><a href="javascript:;" reveal-id="TB4" data-open="TB4" class="link link-reveal link-table xref-fig">Table 4</a>).</p> <a id="494610760" scrollto-destination="494610760"></a> <div content-id="TB4" class="table-modal table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB4" data-id="TB4"><span class="label title-label" id="label-12670">Table 4</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/494610760" aria-describedby="label-12670"> Open in new tab </a></div><div class="caption caption-id-" id="caption-12670"><p class="chapter-para">Reported barriers to delirium care</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-12670" aria-describedby="
 caption-12670"><thead><tr><th>Survey responses (<em>n</em>, %)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn3"></span><a href="javascript:;" reveal-id="tblfn3" data-open="tblfn3" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Shortage of personnel/staff</td><td>903 (54.3)</td></tr><tr><td>Lack of time to educate and train staff</td><td>809 (48.6)</td></tr><tr><td>Missing knowledge about delirium</td><td>632 (38.0)</td></tr><tr><td>Lack of awareness</td><td>585 (35.2)</td></tr><tr><td>Patients who are difficult for assessment</td><td>538 (32.3)</td></tr><tr><td>Communication gaps between professions</td><td>535 (32.2)</td></tr><tr><td>Lack of non-pharmacological interventions</td><td>357 (21.5)</td></tr><tr><td>Not enough motivated staff</td><td>328 (19.7)</td></tr><tr><td>No cost/resources for promoting at the department</td><td>301 (18.1)</td></tr><tr><td>Missing attitude, delirium is not important</td><td>299 (18.0)</td></tr><tr><td>Other problems are more challenging</td><td>275 (16.5)</td></tr><tr><td>No appropriate scores for assessment of delirium</td><td>254 (15.3)</td></tr><tr><td>We have no barriers, delirium is regularly assessed</td><td>170 (10.2)</td></tr><tr><td>Leadership does not support</td><td>137 (8.2)</td></tr><tr><td>Lack of pharmacological interventions</td><td>100 (6.0)</td></tr><tr><td>Interprofessional conflicts</td><td>97 (5.8)</td></tr><tr><td>Missing data</td><td>93 (5.6)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th>Survey responses (<em>n</em>, %)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn3"></span><a href="javascript:;" reveal-id="tblfn3" data-open="tblfn3" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Shortage of personnel/staff</td><td>903 (54.3)</td></tr><tr><td>Lack of time to educate and train staff</td><td>809 (48.6)</td></tr><tr><td>Missing knowledge about delirium</td><td>632 (38.0)</td></tr><tr><td>Lack of awareness</td><td>585 (35.2)</td></tr><tr><td>Patients who are difficult for assessment</td><td>538 (32.3)</td></tr><tr><td>Communication gaps between professions</td><td>535 (32.2)</td></tr><tr><td>Lack of non-pharmacological interventions</td><td>357 (21.5)</td></tr><tr><td>Not enough motivated staff</td><td>328 (19.7)</td></tr><tr><td>No cost/resources for promoting at the department</td><td>301 (18.1)</td></tr><tr><td>Missing attitude, delirium is not important</td><td>299 (18.0)</td></tr><tr><td>Other problems are more challenging</td><td>275 (16.5)</td></tr><tr><td>No appropriate scores for assessment of delirium</td><td>254 (15.3)</td></tr><tr><td>We have no barriers, delirium is regularly assessed</td><td>170 (10.2)</td></tr><tr><td>Leadership does not support</td><td>137 (8.2)</td></tr><tr><td>Lack of pharmacological interventions</td><td>100 (6.0)</td></tr><tr><td>Interprofessional conflicts</td><td>97 (5.8)</td></tr><tr><td>Missing data</td><td>93 (5.6)</td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para">The survey responses of participants are summarised in <span class="xrefLink" id="jumplink-TB4"></span><a href="javascript:;" reveal-id="TB4" data-open="TB4" class="link link-reveal link-table xref-fig">Table 4</a>. These responses answered the question ‘On this unit or ward, barriers against implementation and/or use of evidence-based strategies are … (click all that apply)’</p><span id="fn-tblfn3"></span><div content-id="tblfn3" class="footnote"><span class="fn"><p class="chapter-para"><sup>a</sup>Multiple responses, total percent >100%.</p></span></div></div></div></div><div class="table-full-width-wrap"><div class="table-wrap table-wide standard-table"><div class="table-wrap-title" id="TB4" data-id="TB4"><span class="label title-label" id="label-12670">Table 4</span><div class="
 graphic-wrap table-open-button-wrap
 "><a class="fig-view-orig at-tableViewLarge openInAnotherWindow btn js-view-large" role="button" target="_blank" href="
 /view-large/494610760" aria-describedby="label-12670"> Open in new tab </a></div><div class="caption caption-id-" id="caption-12670"><p class="chapter-para">Reported barriers to delirium care</p></div> </div><div class="table-overflow"><table role="table" aria-labelledby="
 label-12670" aria-describedby="
 caption-12670"><thead><tr><th>Survey responses (<em>n</em>, %)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn3"></span><a href="javascript:;" reveal-id="tblfn3" data-open="tblfn3" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Shortage of personnel/staff</td><td>903 (54.3)</td></tr><tr><td>Lack of time to educate and train staff</td><td>809 (48.6)</td></tr><tr><td>Missing knowledge about delirium</td><td>632 (38.0)</td></tr><tr><td>Lack of awareness</td><td>585 (35.2)</td></tr><tr><td>Patients who are difficult for assessment</td><td>538 (32.3)</td></tr><tr><td>Communication gaps between professions</td><td>535 (32.2)</td></tr><tr><td>Lack of non-pharmacological interventions</td><td>357 (21.5)</td></tr><tr><td>Not enough motivated staff</td><td>328 (19.7)</td></tr><tr><td>No cost/resources for promoting at the department</td><td>301 (18.1)</td></tr><tr><td>Missing attitude, delirium is not important</td><td>299 (18.0)</td></tr><tr><td>Other problems are more challenging</td><td>275 (16.5)</td></tr><tr><td>No appropriate scores for assessment of delirium</td><td>254 (15.3)</td></tr><tr><td>We have no barriers, delirium is regularly assessed</td><td>170 (10.2)</td></tr><tr><td>Leadership does not support</td><td>137 (8.2)</td></tr><tr><td>Lack of pharmacological interventions</td><td>100 (6.0)</td></tr><tr><td>Interprofessional conflicts</td><td>97 (5.8)</td></tr><tr><td>Missing data</td><td>93 (5.6)</td></tr></tbody></table></div><div class="table-modal"><table><thead><tr><th>Survey responses (<em>n</em>, %)<span aria-hidden="true" style="display: none;"> . </span></th><th><em>n</em> = 1664 units<span class="xrefLink" id="jumplink-tblfn3"></span><a href="javascript:;" reveal-id="tblfn3" data-open="tblfn3" class="link link-ref link-reveal xref-fn js-xref-fn"><sup>a</sup></a><span aria-hidden="true" style="display: none;"> . </span></th></tr></thead><tbody><tr><td>Shortage of personnel/staff</td><td>903 (54.3)</td></tr><tr><td>Lack of time to educate and train staff</td><td>809 (48.6)</td></tr><tr><td>Missing knowledge about delirium</td><td>632 (38.0)</td></tr><tr><td>Lack of awareness</td><td>585 (35.2)</td></tr><tr><td>Patients who are difficult for assessment</td><td>538 (32.3)</td></tr><tr><td>Communication gaps between professions</td><td>535 (32.2)</td></tr><tr><td>Lack of non-pharmacological interventions</td><td>357 (21.5)</td></tr><tr><td>Not enough motivated staff</td><td>328 (19.7)</td></tr><tr><td>No cost/resources for promoting at the department</td><td>301 (18.1)</td></tr><tr><td>Missing attitude, delirium is not important</td><td>299 (18.0)</td></tr><tr><td>Other problems are more challenging</td><td>275 (16.5)</td></tr><tr><td>No appropriate scores for assessment of delirium</td><td>254 (15.3)</td></tr><tr><td>We have no barriers, delirium is regularly assessed</td><td>170 (10.2)</td></tr><tr><td>Leadership does not support</td><td>137 (8.2)</td></tr><tr><td>Lack of pharmacological interventions</td><td>100 (6.0)</td></tr><tr><td>Interprofessional conflicts</td><td>97 (5.8)</td></tr><tr><td>Missing data</td><td>93 (5.6)</td></tr></tbody></table></div><div class="table-wrap-foot"><p class="chapter-para">The survey responses of participants are summarised in <span class="xrefLink" id="jumplink-TB4"></span><a href="javascript:;" reveal-id="TB4" data-open="TB4" class="link link-reveal link-table xref-fig">Table 4</a>. These responses answered the question ‘On this unit or ward, barriers against implementation and/or use of evidence-based strategies are … (click all that apply)’</p><span id="fn-tblfn3"></span><div content-id="tblfn3" class="footnote"><span class="fn"><p class="chapter-para"><sup>a</sup>Multiple responses, total percent >100%.</p></span></div></div></div></div> <h2 scrollto-destination=494610761 id="494610761" class="section-title js-splitscreen-section-title" data-legacy-id=sec25>Discussion</h2> <p class="chapter-para">This cross-sectional survey study represents the first global point prevalence study on delirium, covering 6 continents, 44 countries, 1664 wards/units and aggregate data from 36 048 patients at 8:00 a.m. and 32 867 at 8:00 p.m. The prevalence of delirium assessed with validated tools at 8:00 a.m. and 8:00 p.m. was 18% and 17.7%, respectively. While the use of validated tools was reported in 60%–61% of completed surveys, personal judgment was indicated in 18.6% of the surveys, indicating a large knowledge gap in clinical practice. Furthermore, one-third of survey respondents indicated that delirium is only assessed upon an observed sudden change in consciousness. This is contrary to best-practice recommendations of routine delirium assessment and substantiates the existing knowledge gap between research and clinical practice [<span class="xrefLink" id="jumplink-ref1"></span><a href="javascript:;" reveal-id="ref1" data-open="ref1" class="link link-ref link-reveal xref-bibr">1</a>, <span class="xrefLink" id="jumplink-ref17"></span><a href="javascript:;" reveal-id="ref17" data-open="ref17" class="link link-ref link-reveal xref-bibr">17</a>, <span class="xrefLink" id="jumplink-ref18"></span><a href="javascript:;" reveal-id="ref18" data-open="ref18" class="link link-ref link-reveal xref-bibr">18</a>]. Multilevel modelling demonstrated that the continent and type of hospital explain approximately one-third of the observed variation in reported rates of clinically documented delirium. Implications of this study are far-reaching as delirium represents a global public health problem [<span class="xrefLink" id="jumplink-ref19"></span><a href="javascript:;" reveal-id="ref19" data-open="ref19" class="link link-ref link-reveal xref-bibr">19</a>]. Substantial efforts to implement and adopt best-practice recommendations for delirium assessment into clinical practice are needed so that the delirium is routinely and effectively assessed with validated tools.</p><p class="chapter-para">To our knowledge, this is the first study using a broad survey approach to understand the global point prevalence of delirium. The prevalence rates are comparative to a recent meta-analysis summarising nine point prevalence studies with an estimated delirium point prevalence of 22.3% (95% confidence interval 17.8%, 27.7%) [<span class="xrefLink" id="jumplink-ref20"></span><a href="javascript:;" reveal-id="ref20" data-open="ref20" class="link link-ref link-reveal xref-bibr">20</a>]. However, the report differs from the current study in terms of differences between clinical settings and countries. The current study identified significant differences between continents, ward/unit types, age groups and disciplines reported on the unit. <span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499099&Signature=jwIkxK-Oss0CDTQcbbb3tDqCZbX~kkNo85RnGTt4AJg4OWoOnYcttrO3qWgZ7oQPskwrOLOYZilky5754HDhdnCxuIhYoo204QI~ULtBsAhllVBJRvLitatrO4xticrJPI0onmnzwebuAJFXejWIxetUFqOM-IlPMooE5DnWh-6bn1ZlcQsNhN7ihfKVF9LrRYfbL-Kl09oHvAjbaBpBbR8acgmVll5leAiM2T43pR4O0SlTJWtxU8dJ4JzS7XOnP~2C7Z5-LnXpZcVwKqTUYIDGyBgO2asOhK0nqYRVq6uSi21BSWN-mIZ4gNINnCTFkxBlUQrcMpeV4261v8JH~A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S9</a></span> compares the meta-analysis results to the current point prevalence study. The review, nor the included studies, reported on the use of validated tools versus non-validated approaches across two different timepoints. This comparison is essential to consider as a metric for future point prevalence studies as it aids in identifying practice gaps. Future studies should further examine how the continent and type of hospital contribute to varying delirium prevalence rates.</p><p class="chapter-para">There is evidence that upwards of 70% of delirium is missed in clinical care [<span class="xrefLink" id="jumplink-ref21 ref22 ref23 ref24"></span><a href="javascript:;" reveal-id="ref21 ref22 ref23 ref24" data-open="ref21 ref22 ref23 ref24" class="link link-ref link-reveal xref-bibr">21–24</a>]. The binational point prevalence study conducted by Elliot et al. (2013) across 41 ICUs may provide a more representative sample of existing practices, finding that 3% of patients were routinely assessed for delirium [<span class="xrefLink" id="jumplink-ref25"></span><a href="javascript:;" reveal-id="ref25" data-open="ref25" class="link link-ref link-reveal xref-bibr">25</a>]. This finding is similar to a point prevalence survey study completed in Portugal, which reported that delirium assessment was performed in <10% of ICU patients [<span class="xrefLink" id="jumplink-ref26"></span><a href="javascript:;" reveal-id="ref26" data-open="ref26" class="link link-ref link-reveal xref-bibr">26</a>]. Many studies have identified the knowledge and practice gap in clinical practice, citing the lack of resources among the top barriers. The reported barriers in this survey are not different. The lack of resources (staff and time) and knowledge deficits were reported as the top three barriers to the use of evidence-based strategies. Recent publications highlight the need for healthcare agencies, institutions and educational curriculums to incorporate recommended training on delirium and to consider a system-based approach to allocate the needed resources to facilitate the integration of evidence-based care practices [<span class="xrefLink" id="jumplink-ref19"></span><a href="javascript:;" reveal-id="ref19" data-open="ref19" class="link link-ref link-reveal xref-bibr">19</a>, <span class="xrefLink" id="jumplink-ref27"></span><a href="javascript:;" reveal-id="ref27" data-open="ref27" class="link link-ref link-reveal xref-bibr">27</a>, <span class="xrefLink" id="jumplink-ref28"></span><a href="javascript:;" reveal-id="ref28" data-open="ref28" class="link link-ref link-reveal xref-bibr">28</a>]. The incorporation of recommended training and integration of evidence-based care practices with the needed resources may decrease the downstream impact of delirium on hospital length of stay and cognitive decline including dementia [<span class="xrefLink" id="jumplink-ref19"></span><a href="javascript:;" reveal-id="ref19" data-open="ref19" class="link link-ref link-reveal xref-bibr">19</a>, <span class="xrefLink" id="jumplink-ref29"></span><a href="javascript:;" reveal-id="ref29" data-open="ref29" class="link link-ref link-reveal xref-bibr">29</a>, <span class="xrefLink" id="jumplink-ref30"></span><a href="javascript:;" reveal-id="ref30" data-open="ref30" class="link link-ref link-reveal xref-bibr">30</a>].</p><p class="chapter-para">Multicomponent, non-pharmacological, bundled interventions such as the ABCDEF bundle or the HELP program have repeatedly demonstrated effectiveness in the reduction or prevention of delirium [<span class="xrefLink" id="jumplink-ref2"></span><a href="javascript:;" reveal-id="ref2" data-open="ref2" class="link link-ref link-reveal xref-bibr">2</a>, <span class="xrefLink" id="jumplink-ref31 ref32 ref33 ref34 ref35"></span><a href="javascript:;" reveal-id="ref31 ref32 ref33 ref34 ref35" data-open="ref31 ref32 ref33 ref34 ref35" class="link link-ref link-reveal xref-bibr">31–35</a>]. Yet, their adoption to practice is limited and often short-lived, dependent on individual champions of evidence [<span class="xrefLink" id="jumplink-ref11 ref12 ref13"></span><a href="javascript:;" reveal-id="ref11 ref12 ref13" data-open="ref11 ref12 ref13" class="link link-ref link-reveal xref-bibr">11–13</a>]. Pain management, mobilisation and adequate fluids were the top three reported non-pharmacological interventions to manage delirium. These are each essential components of multicomponent, non-pharmacological, bundled interventions. It is revealing that other essential components, such as re-orientation, were reported <75% of the time. This finding informs future projects and studies implementing delirium prevention interventions into routine clinical practice. Existing resources and learnings from previous implementation studies could further the chances of successful practice change [<span class="xrefLink" id="jumplink-ref11"></span><a href="javascript:;" reveal-id="ref11" data-open="ref11" class="link link-ref link-reveal xref-bibr">11</a>, <span class="xrefLink" id="jumplink-ref36 ref37 ref38 ref39 ref40 ref41 ref42 ref43"></span><a href="javascript:;" reveal-id="ref36 ref37 ref38 ref39 ref40 ref41 ref42 ref43" data-open="ref36 ref37 ref38 ref39 ref40 ref41 ref42 ref43" class="link link-ref link-reveal xref-bibr">36–43</a>].</p><p class="chapter-para">The use of pharmacologics to prevent delirium is not supported by evidence, specifically benzodiazepines, haloperidol or quetiapine [<span class="xrefLink" id="jumplink-ref44 ref45 ref46 ref47"></span><a href="javascript:;" reveal-id="ref44 ref45 ref46 ref47" data-open="ref44 ref45 ref46 ref47" class="link link-ref link-reveal xref-bibr">44–47</a>]. Several studies have shown that benzodiazepines increase the risk of delirium and their use to sedate or treat agitation should be avoided [<span class="xrefLink" id="jumplink-ref48 ref49 ref50 ref51"></span><a href="javascript:;" reveal-id="ref48 ref49 ref50 ref51" data-open="ref48 ref49 ref50 ref51" class="link link-ref link-reveal xref-bibr">48–51</a>]. A study in a palliative care population reported increased delirium symptom profiles in the intention-to-treat arms for haloperidol and risperidone [<span class="xrefLink" id="jumplink-ref45"></span><a href="javascript:;" reveal-id="ref45" data-open="ref45" class="link link-ref link-reveal xref-bibr">45</a>]. For pharmacological management, both haloperidol and quetiapine are recommended in some guidelines for the reduction of hyperactive delirium symptoms (i.e. agitation) to maintain patient safety. Other guidelines, such as the Australian Clinical Standards, strongly recommend the avoidance of antipsychotics [<span class="xrefLink" id="jumplink-ref52"></span><a href="javascript:;" reveal-id="ref52" data-open="ref52" class="link link-ref link-reveal xref-bibr">52</a>]. In most guidelines, there is a clear recommendation to exhaust all non-pharmacological options and reconsider all contraindications before opting for antipsychotics [<span class="xrefLink" id="jumplink-ref1"></span><a href="javascript:;" reveal-id="ref1" data-open="ref1" class="link link-ref link-reveal xref-bibr">1</a>, <span class="xrefLink" id="jumplink-ref2"></span><a href="javascript:;" reveal-id="ref2" data-open="ref2" class="link link-ref link-reveal xref-bibr">2</a>, <span class="xrefLink" id="jumplink-ref49"></span><a href="javascript:;" reveal-id="ref49" data-open="ref49" class="link link-ref link-reveal xref-bibr">49</a>, <span class="xrefLink" id="jumplink-ref53"></span><a href="javascript:;" reveal-id="ref53" data-open="ref53" class="link link-ref link-reveal xref-bibr">53</a>, <span class="xrefLink" id="jumplink-ref54"></span><a href="javascript:;" reveal-id="ref54" data-open="ref54" class="link link-ref link-reveal xref-bibr">54</a>]. The results of this survey indicate that best-practice recommendations may not be followed. Future awareness campaigns and quality improvement projects should aim to address this knowledge and practice gap.</p> <h3 scrollto-destination=494610767 id="494610767" class="section-title js-splitscreen-section-title" data-legacy-id=sec26>Implications for future research</h3> <p class="chapter-para">A global infrastructure for future delirium research was established through the design and conduct of the reported survey study. Future research studies can use this infrastructure to further examine the differences between wards/units, healthcare systems and countries in their adoption and use of best practices for delirium care. Future quality improvement projects could leverage the global infrastructure to learn from the success and failure of previous projects focused on the implementation of best practices for delirium care. A secondary analysis of this survey study identified that the presence of delirium management protocols increased the likelihood of the use of validated delirium assessment tools. Future projects could include policy recommendations at the country level to establish delirium care standards, similar to Australia.</p> <h3 scrollto-destination=494610769 id="494610769" class="section-title js-splitscreen-section-title" data-legacy-id=sec27>Limitations and strengths</h3> <p class="chapter-para">While being the first global estimates of delirium, the study reported has five central limitations. These include selection bias, study design, survey design, non-response bias and the validity of reported clinical delirium assessments. These are outlined and discussed below.</p><p class="chapter-para">First, the findings of this study may be influenced by selection bias as clinicians and scientists interested in delirium may have been more likely to participate in the survey. Therefore, the survey findings may represent hospital systems and units that are aware of delirium and not be representative of overall healthcare settings.</p><p class="chapter-para">Second, a cross-sectional, observational, survey-based study design was used, limiting the ability to examine causal relationships among variables and draw substantive conclusions. Multivariable modelling was not possible due to the lack of patient-level data. The survey encompassed several different types of healthcare settings (i.e. ICU, general care, rehabilitation facilities) and therefore there may be differences between settings that is not shown in this reporting.</p><p class="chapter-para">Third, non-response bias may have influenced reported delirium prevalence rates. Due to the design of the survey, it is not possible to discern information related to incompleteness at a survey stage. Incomplete surveys could represent several different clinical scenarios as respondents started the survey but were unable to, or choose not to, proceed past the consent point. <span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499099&Signature=jwIkxK-Oss0CDTQcbbb3tDqCZbX~kkNo85RnGTt4AJg4OWoOnYcttrO3qWgZ7oQPskwrOLOYZilky5754HDhdnCxuIhYoo204QI~ULtBsAhllVBJRvLitatrO4xticrJPI0onmnzwebuAJFXejWIxetUFqOM-IlPMooE5DnWh-6bn1ZlcQsNhN7ihfKVF9LrRYfbL-Kl09oHvAjbaBpBbR8acgmVll5leAiM2T43pR4O0SlTJWtxU8dJ4JzS7XOnP~2C7Z5-LnXpZcVwKqTUYIDGyBgO2asOhK0nqYRVq6uSi21BSWN-mIZ4gNINnCTFkxBlUQrcMpeV4261v8JH~A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Figure S2</a></span> outlines missing survey data.</p><p class="chapter-para">Fourth, the design of the survey may have introduced bias. Data points within the survey were designed for feasibility of completion in busy clinical environments. Therefore, broad concepts and aggregate data available in the electronic health record were prioritised over the granularity of data (i.e. patient-level factors like biological sex, genetics, cognition). This study design limits the ability to examine patient-level data in relation to patterns of missingness or relationships between risk factors, tools or other patient-level characteristics.</p><p class="chapter-para">Lastly, we were not able to verify data collection or entry strategies by each institution. We did exclude invalid assessment methods from the prevalence estimates. As the study design did not allow for the verification of clinically documented assessments, the training process of the clinical assessors or the accuracy of documented assessments, the results should be interpreted cautiously.</p><p class="chapter-para">Future point prevalence studies focused on delirium can further address these limitations by improving study and survey design, outlined in <span class="link link-data-supplement" data-supplement-target="sup1"></span><span class="content-section supplementary-material"><a path-from-xml="sup1" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/aa-24-0753-file003_afae248.docx?Expires=1735499099&Signature=jwIkxK-Oss0CDTQcbbb3tDqCZbX~kkNo85RnGTt4AJg4OWoOnYcttrO3qWgZ7oQPskwrOLOYZilky5754HDhdnCxuIhYoo204QI~ULtBsAhllVBJRvLitatrO4xticrJPI0onmnzwebuAJFXejWIxetUFqOM-IlPMooE5DnWh-6bn1ZlcQsNhN7ihfKVF9LrRYfbL-Kl09oHvAjbaBpBbR8acgmVll5leAiM2T43pR4O0SlTJWtxU8dJ4JzS7XOnP~2C7Z5-LnXpZcVwKqTUYIDGyBgO2asOhK0nqYRVq6uSi21BSWN-mIZ4gNINnCTFkxBlUQrcMpeV4261v8JH~A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Table S3</a></span>.</p> <h3 scrollto-destination=494610777 id="494610777" class="section-title js-splitscreen-section-title" data-legacy-id=sec28>Strengths</h3> <p class="chapter-para">Strengths of this study include its design, interprofessional team involvement and global representation. All the principal investigators are known experts in delirium. An interprofessional team of scientists and clinicians across disciplines assisted with survey development, testing and deployment across six continents, representing 44 countries. These data provide a diverse clinical picture as various units and cultures are involved. Lastly, this survey requested aggregate data on delirium assessments at two time points, providing a comprehensive clinical picture of delirium prevalence.</p> <h2 scrollto-destination=494610779 id="494610779" class="section-title js-splitscreen-section-title" data-legacy-id=sec29>Conclusion</h2> <p class="chapter-para">This study reports results from the first global point prevalence study on delirium, covering 6 continents, 44 countries and 1664 units, and the point prevalence of clinically documented delirium was 18% at 8:00 a.m. and 17.7% at 8:00 p.m. Reported delirium management strategies do not consistently follow best-practice recommendations and the reported barriers were all resource related. Future studies and quality improvement projects can use these findings as a baseline to measure future advancements in improving delirium care.</p> <h2 scrollto-destination=494610781 id="494610781" class="backacknowledgements-title js-splitscreen-backacknowledgements-title" data-legacy-id=afae248-ack>Acknowledgements</h2> <p class="chapter-para">H.L. and P.N. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The WDAD Study Team would like to thank the American Delirium Society, Australian Delirium Association, European Delirium Association, iDelirium and Latin American Delirium Interest Group for their support of this study. The authors would like to gratefully acknowledge participating clinicians and researchers for supporting the study and contributing information. The contributors who approved their mention are listed in—link to the <span class="link link-data-supplement" data-supplement-target="sup2"></span><span class="content-section supplementary-material"><a path-from-xml="sup2" href="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ageing/53/11/10.1093_ageing_afae248/1/supplementary_material_ageing_nov2024_afae248.docx?Expires=1735499099&Signature=kx4jidPmeo~88WM68kd6iy1pEV2tqE9cUiLj~Finfnjef2R6aZn7HnIHXamlG1amYYRybcPnvplnb5FmnTkaMaPGfGfkHeMfR~zZ9YrebREMe-akQgZLBtdnhgSvafGiMiAgyOsMBeI24C8kiQgsjzBBMLJklln5xttW7rCSzA~SKSdNA0iR1~M~cF71-KMoPQkEzDk8TbIJ6l6y8QQAyulP75LuAJCPdD0~Fd6yGhHGfcN9YVOWtV9QlrtImwgkMNT3OIAwtVP7UOwSzkAXCG7~y8eDKFst5MPn-OMS0W3D465oEBvrb-nsKQQLvE1GUZblA2Qsx9uvpR4eKPGBUg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA">Supplementary Data File</a></span> – ‘WDAD_Study_Team-2023-Update-24-07-27’.</p> <h2 scrollto-destination=494610783 id="494610783" class="backsection-title js-splitscreen-backsection-title" data-legacy-id=sec30>Declaration of Conflicts of Interest</h2> <p class="chapter-para">H.L. is funded by the NIA 1AGK23076662-02, serves as a board member for the American Delirium Society and was the 2023 conference co-chair for the American Delirium Society, and serves as the web committee chair for the American Thoracic Society, Nursing Assembly. She has received royalties for keynote addresses at nursing conferences in 2022 and received a travel scholarship to attend the 2023 DECLARED conference in Sydney, Australia and the 2024 Hunters Geriatrics Conference in Newcastle, Australia. G.C. is the Past President of the Australian Delirium Association. M.G. has received royalties for the edited books (<em>Manual of ICU Procedures</em>, <em>Textbook of Ventilation Fluids, Electrolytes, and Blood Gases</em>) from the publisher Jaypee Brothers Medical Publishers and has received financial support to attend the Annual Conference of Indian Society of Critical Care Medicine. G.H.C. has spoke on Humanization of Healthcare (Pfizer) and was supported by Pfizer to attend the COMMEC 2022 meeting. E.S.O. is supported by NIH/NIA funding (unrelated to this manuscript), received honoraria to present at the Edmund Beacham Annual Current Topics in Geriatrics, has patents issued or pending, and was the 2022 President of the American Delirium Society. M.O.C. received funding unrelated to this manuscript from Novo Fonden, Lundbeck Funden and Dagmar Marshells Fond. R.V.H. received support from OrionPharma to attend meetings and/or travel.</p> <h2 scrollto-destination=494610785 id="494610785" class="backsection-title js-splitscreen-backsection-title" data-legacy-id=sec31>Declaration of Sources of Funding</h2> <p class="chapter-para">This study was not financially supported. H.L. is supported by a National Institute on Health, National Institute on Aging, 5K23AG076662-02. 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class="article-metadata-standalone-panel clearfix"></div> <h2 class="authorNotes-section-title" id="authorNotesSectionTitle" scrollto-destination="authorNotesSectionTitle">Author notes</h2> <div content-id="afn1" class="footnote"><span class="fn"><div class="footnote-content"><p class="footnote-compatibility">Acknowledgement of Collaborative Authorship: The World Delirium Awareness Day (WDAD) Study Team consists of: Ahmed Gaber Ahmed Abdalgany, MBBCH, Sarah Magdy Abdelmohsen, M.D., Amjad Aburaas, M.D., Christina Aggar, M.D., Bashir Abobaker Albakosh, M.D., Hamza Ismail Ahmad Alhamdan, M.D., Akram Waled Rajab M Aljbali, M.D., Farah Alkandari, M.D., Akram Alkaseek, MBBCh, MRCS, Daniel Anders, R.N., Marsali Anderson, MB ChB, BSc, Thiago Avelino, Kasia Siobhan Bail, Ashraf Bakri, M.D., Alaa Mohamed Ali Baroum, Julie Benbenishty, Ph.D., MNS, R.N., Bronagh Blackwood, Ph.D., Jennifer Brendt-Müller, MSc, Angelika Brobeil, BBA, Richard Burke, M.D., Tru Byrnes, D.N.P., Stefano Cacciatore, M.D., Maria Cahill, MSc, Maria Ana Canelas, Ida Carroll, MSc, Amy Conley, MbChB, Maria Costello, M.D., Shannon Cotton, R.N., Mandy Couser, BSc, Ana Rita Cunha Salgado, M.D., Elizabeth Cusworth, MS, Vera Cvoro, M.D., Jordanna Deosaran, M.D., Merel Diebels, MSc, Elaine A. Docherty, MHp, Vera von Dossow, M.D., Megan Drennan, M.D., Akram Amin Egdeer, MBBCh, Patrick Eichelsheim, MANP, Aissha Ali Saleh Elagili, M.D., Saifaleslam Jamal Elsahl, M.D., Hajer Alsadeg Mohammed Elshaikh, M.D., Christina Emme, Ph.D., Matthias Thomas Exl, MSc, Azza Fathi, M.D., Melanie Feige, Dipl. Paed., Kirsten Fiest, Ph.D., Marleta Irene Joy Fong, MsN, Mikita Fuchita, M.D., Carol Gaffney, M.D., Carola Gimenez-Esparza Vich, M.D., Nicole Feldmann, MSc, Rachel Fitzgerald, M.D., Neasa Fitzpatrick, M.D., Marleta Irene Joy Fong, MN CN, Maria Adela Goldberg, M.D., Nienke Golüke, M.D., Mirjam de Graaf, MSc, Engelina Groenewald, M.D., Renate Gross, M.D., Camilla Grube Segers, M.D., Renate Hadi, R.N., Qusai Ahmad Hasan Hamdan, BS, Bahaeddin Ben Hamida, MBBCh, Mohamed Hassan Hamza. M.D., Breanna Hetland, Ph.D., Jane Adele Hopkins, MHA, John Hopkins, MBChB, FRCPsych, Sarah Ahmed Atef Mohamed Ibrahim, MBBCH, Guglielmo Imbriaco RN MSN, on behalf of Aniarti, Italian Association of Critical Care Nurses, Azienda USL di Bologna Italy, Shigeaki Inoue, Ph.D., Arveen Jeyaseelan, M.D., Ali Jawad Kadhim, MBChB, Sabrina Kohler, MBBS FRACP, Rens Kooken, M.D., Anna St. Korompeli, Ph.D., Lars Krüger, MSc, Ayman Salim Abu Khutwah, Puck de Lange, M.D., Sharon Liefrink, R.N., Yu-min Lin, M.D., Shi Pei Loo, M.D., Sara Beatriz Lopes Rodrigues, M.D., Allan MacDonald, M.D., Gillian Madders, M.D., Claudia Massaro, M.D., Kerri Maya, MSL, Sofia Manioudaki, M.D., Natalie McAndrew, P.hD., Stewart McKenna, M.D., Isabel Maria Metelo Coimbra, M.D., Teresa Miranda, M.D., Mohamed Anwar Abdelsalam Mohamed, M.D., Mushin Mohammed Elhadi Agbna Mohammed, M.D., Malissa Mulkey, Ph.D., Fariha Naeem, M.D., Kensuke Nakamura, Ph.D., Mi-Ryeo Nam, Elaine Newman, MSc, Renae Nicol, CNC, Claire Noonan, Msc AP, Maria Inês Nunes Oliveira Lopes, M.D., Zina Otmani, Cynthia Olotu, M.D., Alice Margherita Ornago, M.D., Susan O’Reilly, MSc, Valerie Ozorio, M.D., Jessica Palakashappa, M.D., Tej Pandya, M.D., Panagiota Papadea, M.D., Metaxia Papanikolaou, M.D., Rose S. Penfold, MPH, Elena Pinardi, M.D., Inês Filipa Pinto Pereira, M.D., Chirantha Premathilaka, M.D., Monica Pop-Purceleanu, M.D., Marlene Puchegger, BSc, Nouralddeen Mohammed Qalhoud, M.D., Terence J. Quinn, M.D., Maike Raasing, Ph.D., Dalia Talaat Ragheb, M.D., Prasad Rajhans, M.D., Nuri Ramadan, M.D., Mushabbir Hossain Rubel, M.D., Kate Sainsbury, BSc, Francesco Salis, M.D., Florian Schimböck, MSc Med, Roman Schmädig, MSc, Yvonne Schoon, M.D., Deepak Sethia, M.D., Edith Sextl, MScN, Bhagyesh Shah, M.D., Dua’a Shaout, M.D., Alaa Fouad Sharabi, M.D., Lynn Shields, M.D., Kendall Smith, M.D., Linda Smulders-van Dam, MSc, Roy L Soiza, M.D., Andrea Spiegler, MSc, Lucy Stocks, MBBS, Stefan Sumerauer, MSc, Stephanie Tam, BSc, Aik Haw Tan, MBChB, FRACP, Suzanne Timmons, Ph.D., Peter Tohsche, MScN, Raquel Gouveia Torres, M.D., Chantal Toth, D.N.P., Vasiliki Tsolaki, Ph.D., Iben Tousgaard, MPH, Roberta Esteves Vieira de Castro, Birgit Vogt, M.D., Erica Walsh, M.D., Kristel Ward-Stockham, MANP, Melinda Webb-St. Mart, MPH, Franziska Wefer, MSc, Mariajne Elisabeth Wijnen-Meijer, Ph.D., Hilde Wøien, M.D., Inke Zastrow, MSc, Maria Beatrice Zazzara, M.D.</p></div></span></div><div class="copyright copyright-statement">© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.</div><div class="license"><div class="license-p">This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<a class="link link-uri openInAnotherWindow" href="https://creativecommons.org/licenses/by-nc/4.0/" target="_blank">https://creativecommons.org/licenses/by-nc/4.0/</a>), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. 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