Investigation of the prevalence of delirium, pain, mobilization indices, frailty, and muscle weakness in patients admitted to wards

Abstract

Introduction: Patients admitted to wards are subject to complicated situations such as the emergence of delirium, the presence of pain and the development of muscle weakness or frailty. Low mobilization rates are also associated with adverse events, increasing morbidity and mortality in this population. Aims: 1) Investigate the prevalence of delirium, pain, frailty and muscle weakness in patients admitted to wards. 2) Characterize the mobilization pattern adopted with patients. Methods: Cohort study that followed patients admitted to the clinical and surgical wards of Hospital e Maternidade São Cristóvão (HMSC) who were monitored during their hospitalization, in 03 assessments (beginning, intermediate and end of hospitalization). Delirium was assessed using the 3D-CAM questionnaire. Pain was investigated using a pain body map and the pain visual analogue scale (VAS). Frailty was studied using the CFS scale (Clinical Frailty Scale). Weakness was investigated using the MRC scale (Medical Research Council) and the handgrip dynamometer (Saehan®). Finally, the mobilization indices adopted with the patients were measured using the JHMS (Johns Hopkins Mobility Scale). Data were presented as mean and standard deviation and absolute and relative frequency. The student’s t test and the chi-square test were used, when necessary, assuming values of p≤0.05 as significant. Results: 62 patients were studied (age: 79.8±0.4 years; BMI: 26.4±6.3 kg/m2; 37.5% male). The total hospitalization days were 12.3±8.8 days, with 23.4% of the sample passing through the intensive care unit (ICU), remaining there for 5.9±5.8 days, before being admitted to the infirmary. The main cause of hospital admission was related to the respiratory system (32.9%), followed by the cardiovascular system (21.1%). The delirium observed in the sample was 27.0%, with the hypoactive type being the most prevalent (70.6% of cases). When considering the number of medications used at home versus the number of medications during hospitalization, there was a significant increase in their quantity (home: 4.8±2.8 vs. Hospitalization: 10.8±4.2 medications, p: 0.00), which may be associated with the emergence of delirium. Pain was present in 22.9% of assessments, with an average intensity of 1.1±5.9 points on the VAS. The area most frequently referred to as painful by patients was the lower limbs (47.1%), followed by the abdomen (15.7%). Measured by the CFS, the presence of some degree of fragility/ vulnerability in the sample was 54.7%. In the assessment of strength by MRC, 14.5% of patients presented weakness. Using handgrip dynamometry, 25.1% had weakness and 40.1% had severe weakness. To verify mobilization rates based on JHMS, it was shown that 61.5% of the sample remained in bed throughout their hospitalization and only 7.4% of patients walked, at some point, more than 76 meters during their hospitalization. Mortality in the sample was 7.8%. Conclusions: 1) Important portions of the studied population presented complications and adverse events during their hospitalization. Representative rates of delirium, pain, frailty/vulnerability and weakness were observed. 2) A large portion of the patients evaluated remained in bed during their hospitalization, which could further worsen the emergence of the findings presented here. Implementing assessment tools, systematizing the processes involved and implementing measures that can minimize such situations is fundamental to improving the hospital care.