Feature Article 

Delirium Superimposed on Dementia: Accuracy of Nurse Documentation

Melinda R. Steis, PhD, RN; Donna M. Fick, PhD, RN, FAAN

  • Journal of Gerontological Nursing
  • January 2012 - Volume 38 · Issue 1: 32-42
  • DOI: 10.3928/00989134-20110706-01


Delirium is an acute, fluctuating confusional state that results in poor outcomes for older adults. Dementia causes a more convoluted course when coexisting with delirium. This study examined 128 days of documentation to describe what nurses document when caring for patients with dementia who experience delirium. Nurses did not document that they recognized delirium. Common descriptive terms included words and phrases indicating fluctuating mental status, lethargy, confusion, negative behavior, delusions, and restlessness. Delirium is a medical emergency. Nurses are in need of education coupled with clinical and decisional support to facilitate recognition and treatment of underlying causes of delirium in individuals with dementia.


Dr. Steis is Health Services Research and Development (HSR&D) Postdoctoral Research Fellow, Department of Veterans Affairs Medical Center, Tampa, Florida; and Dr. Fick is Professor of Nursing, School of Nursing, and Professor of Medicine, Department of Psychiatry, The Pennsylvania State University, University Park, Pennsylvania.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. Dr. Steis acknowledges research funding from the Beta Sigma Chapter of the Honor Society of Nursing, Sigma Theta Tau International, and guidance from her dissertation committee: Drs. Donna Fick (chair), Janice Penrod, Susan Loeb, and Robert Schrauf. Dr. Steis also acknowledges mentoring guidance from Drs. Lois Evans and Meredeth Rowe as well as her funding through a National Research Service Award Postdoctoral Fellowship (2009–2010), “Individualized Care for At-Risk Older Adults” (T32NR009356), National Institute of Nursing Research at the University of Pennsylvania School of Nursing; and her current funded position as an HSR&D postdoctoral research fellow at the Department of Veterans Affairs Medical Center, Tampa, Florida.

Address correspondence to Melinda R. Steis, PhD, RN, HSR&D Postdoctoral Research Fellow, Department of Veterans Affairs Medical Center, 8900 Grand Oak Circle, Tampa, FL 33637; e-mail: .Melinda.Steis@va.gov



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