Thesis

92 PART THREE | DELIRIUM ≥ 3 as a cut-off for delirium. It has sensitivity and specificity rates of 92 and 82 percent, respectively [19]. Delirium was recorded as present if the diagnosis was noted in the patient chart, or if the patient had a DOSS score ≥ 3 without a rejection of the delirium diagnosis written down in the chart. The following risk factors were assessed: Age >70 years, alcohol or drug abuse, hearing, visual and/or cognitive impairment, history of delirium, high doses of opioids (>90 mg of oral morphine or equivalent), corticosteroids (>15mg dexamethasone or equivalent) and/or sedatives (>2 mg lorazepam or equivalent), infections, postoperative state (until discharge of major surgery), constipation (note of constipation or note of delayed stool production for >48 hours), urinary retention, tumor burden and location, organ failure and metabolic disturbances [4-10]. In detail these risk factors are depicted in Table 1. To avoid dependence the first admission with or without delirium for each patient was used for comparisons. Table 1. Predisposing and precipitating factors for delirium Predisposing factors Age > 70 years Alcohol or drug abuse Hearing impairment Visual impairment History of delirium Cognitive impairment Precipitating factors Group Factor Cut-off High doses of psychotropic medication Opioids >90 mg morphine per day or equivalent Corticosteroids >15 mg dexamethasone per day or equivalent Sedatives >2 mg lorazepam per day or equivalent Withdrawal Alcohol Sedatives Other Infection Fever >38.5 °C Sepsis Urinary tract infection Pulmonary tract infection Other infections Postoperative state Constipation Urinary retention

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