Quick but challenging test shows if patients can think straight
December, November, October, September… Can you rattle off the months of the year in reverse order?
December, November, October, September…
Can you rattle off the months of the year in reverse order?
Researchers say a failure to do so may be a sign of delirium in hospital patients.
This finding comes from a new study whose lead author was Donna M. Fick, a professor of nursing at Pennsylvania State University.
The goal of the research, published in the Journal of Hospital Medicine, was to look for quicker methods for identifying patients whose mental health is going awry.
Hospital delirium is a vexing problem in older patients, especially for those in the intensive care unit. People who seem mentally sound before admission may start to experience delusions and other problems once in the hospital -- perhaps due to a constellation of factors, such as poor sleep, medications, and underlying mental decline.
Currently, hospitals use a three-minute diagnostic test to screen for delirium, but study authors said that in cases where time is short, a quicker initial test was needed.
Fick, codirector of Penn State's Hartford Center of Geriatric Nursing Excellence, collaborated with researchers at Harvard Medical School, among other institutions.
After testing a variety of questions on 201 patients, the researchers found that two of them seemed especially useful when used in tandem.
One was reciting the months backward. The other was simply stating the day of the week.
Taken together, those two items correctly identified 39 of the 42 patients who in fact were suffering from delirium, as determined later in a rigorous, 45-minute examination.
But that pair of questions also tripped up some people whose mental state was OK. Of the 159 patients without delirium, 57 got at least one of those two questions wrong, in most cases the one about reciting the months backward.
The authors said it was OK to cast too wide a net, because such a two-question screening can be administered quickly, allowing doctors to determine who should then get the longer three-minute exam. They said further research is needed to validate the quick screen in a real-world setting.
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