Biomedical subjects
S M Mlynarczyk
Publications and source records attributed to S M Mlynarczyk.
Predictors of acute confusional states in hospitalized elderly patients.
Development of two models for predicting acute confusional states in elderly post-surgical hip-fracture patients is described. Admission variables were used in the first model to predict confusion in the first five postoperative days; treatment and clinical progress data were added for the second model to predict on a day-to-day basis. The main sample was 170 patients from four hospitals (M age = 78.8) with no prior history of mental impairment. Over half (51.5%) evidenced some confusion postoperatively. Three variables were significant in the admission model: age, errors on a mental status test, and level of pre-injury activity. Age and test errors remained significant in the daily model and urine elimination problems were added, but the strongest predictor was the previous day's confusion score. When that effect was removed, pain, narcotics, and mobility emerged as important predictors. Validity testing suggested that the three admission factors were core predictors of acute confusional states.
Reducing acute confusional states in elderly patients with hip fractures.
The extent to which the incidence of postoperative acute confusional states could be reduced in elderly (greater than or equal to age 60) patients with hip fractures was tested. Interpersonal and environmental nursing interventions were carried out with 57 patients on orthopedic units in three hospitals. The incidence of confusion was reduced from 51.5% in the comparison group (n = 170) to 43.9%. Analysis that controlled for risk factors in the two groups showed the drop in incidence to be significant (p less than .02). The most effective interventions appeared to be those that provided orientation and clarification, corrected sensory deficit, and increased continuity of care.