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Background Neurocognitive disorders (NCDs), including delirium, cognitive impairment, or dementia are prevalent in up to 39% of older adults in acute care, particularly older trauma patients. Undiagnosed NCDs result in poor outcomes, such as increased incidence of depressive symptoms, longer length of stay, and mortality. Objective This study aims to identify the diagnostic test accuracy of screening tools for the detection of NCDs in older trauma patients in acute settings. Design Systematic review protocol. Literature search Electronic databases (MEDLINE, Embase, CINAHL, PsycInfo, Cochrane Library) will be searched for journal articles. Search terms related to NCDs, delirium and cognitive screening tools, and diagnostic accuracy will be included. Study selection criteria Cross-sectional, prospective, or retrospective cohort studies of adults aged ≥60 post-trauma, in an acute setting, will be included where the study aimed to validate a screening tool for detection of 1) delirium or 2) cognitive impairment, or dementia against a reference standard of a clinical decision, based on standardised diagnostic criteria or a validated tool. Data synthesis Two review authors will conduct study selection, data extraction, and appraisal. Data will be extracted based on the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) checklist. Studies will be assessed for methodological quality by two independent review authors using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Narrative summaries will be generated describing risk of bias and concerns regarding applicability. Quantitative synthesis of study findings will be conducted. Conclusion This systematic review will aim to identify screening tools with the best diagnostic accuracy for detection of 1) delirium and 2) cognitive impairment or dementia in adults aged ≥60 post-trauma in acute care settings. Results will inform clinical practice to enhance the probability of patients with NCDs receiving appropriate care and management. Registration PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024518730 (11/03/2024).

Background: Suicide and self-harm are significant public health concerns. Community pharmacies are accessible and frequented regularly by the public, making them well positioned to identify and intervene with those at risk. The aims of this research project are to evaluate pharmacy staff experiences of dealing with people at risk of suicide/self-harm, and explore how best to support staff during these interactions. Methods: Semi-structured online and telephone interviews were conducted with a sample of community pharmacists and community pharmacy staff (CPS) in the south west of Ireland. Interviews were audio recorded and transcribed verbatim. The Braun and Clarke approach to inductive thematic analysis was used to analyse the data. Results: Thirteen semi-structured qualitative interviews were conducted in November–December 2021. Most participants had encountered a person at risk of suicide/self-harm in their practice, however participants described a lack of training and guidelines around how to navigate these scenarios. Three major themes emerged: (i) Interacting with patients at risk of suicide/self-harm- facilitators and barriers; (ii) Referrals and signposting; (iii) Addressing uncertainty. Positive relationships between the person and pharmacy staff facilitated interactions, while privacy, time constraints and uncertainty among staff were seen as barriers. Participants felt it was necessary to refer at-risk people to other supports, and made suggestions for increasing staff confidence through the implementation of support tools within the pharmacy setting. Conclusions: This study highlights that at present, community pharmacy staff feel uncertain regarding how to handle interactions with people at risk of suicide/self-harm, due to lack of training and supports. Future research should focus on building upon existing resources and obtaining specialist and stakeholder input to produce the most effective support tool(s), tailored to the pharmacy setting.

Objectives To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.Design Cross-sectional study.Setting International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants 1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measures Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.Results Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p

Delirium is increasingly considered to be an important determinant of trajectories of cognitive decline. Therefore, analyses of existing cohort studies measuring cognitive outcomes could benefit from methods to ascertain a retrospective delirium diagnosis. This study aimed to develop and validate such a method for delirium detection using routine medical records in UK and Ireland.A point prevalence study of delirium provided the reference-standard ratings for delirium diagnosis. Blinded to study results, clinical vignettes were compiled from participants' medical records in a standardised manner, describing any relevant delirium symptoms recorded in the whole case record for the period leading up to case-ascertainment. An expert panel rated each vignette as unlikely, possible, or probable delirium and disagreements were resolved by consensus.From 95 case records, 424 vignettes were abstracted by 5 trained clinicians. There were 29 delirium cases according to the reference standard. Median age of subjects was 76.6 years (interquartile range 54.6 to 82.5). Against the original study DSM-IV diagnosis, the chart abstraction method gave a positive likelihood ratio (LR) of 7.8 (95% CI 5.7-12.0) and the negative LR of 0.45 (95% CI 0.40-0.47) for probable delirium (sensitivity 0.58 (95% CI 0.53-0.62); specificity 0.93 (95% CI 0.90-0.95); AUC 0.86 (95% CI 0.82-0.89)). The method diagnosed possible delirium with positive LR 3.5 (95% CI 2.9-4.3) and negative LR 0.15 (95% CI 0.11-0.21) (sensitivity 0.89 (95% CI 0.85-0.91); specificity 0.75 (95% CI 0.71-0.79); AUC 0.86 (95% CI 0.80-0.89)).This chart abstraction method can retrospectively diagnose delirium in hospitalised patients with good accuracy. This has potential for retrospectively identifying delirium in cohort studies where routine medical records are available. This example of record linkage between hospitalisations and epidemiological data may lead to further insights into the inter-relationship between acute illness, as an exposure, for a range of chronic health outcomes.