A Quality Improvement Study on Delirium Awareness Day: In Pursuit of Missed Delirium Diagnoses

Koca M., Öztürk Y., Boğa I., Bürkük S., Eşme M., Akyürek Y., ...More

Journal of Gerontological Nursing, vol.48, no.8, pp.43-51, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 48 Issue: 8
  • Publication Date: 2022
  • Doi Number: 10.3928/00989134-20220630-03
  • Journal Name: Journal of Gerontological Nursing
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, Abstracts in Social Gerontology, AgeLine, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.43-51
  • Hacettepe University Affiliated: Yes


The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A’s Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Prevalence of delirium according to clinical impression was 3.3% (n = 4), whereas prevalence was 12.4% (n = 17) according to DSM-5 criteria and 13.8% (n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 (p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults.