The experience of acute confusion in older women with hip fracture

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Brooks, Daryl
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Acute confusion (also known as delirium) occurs frequently in the hospitalized elderly, jeopardizing health outcomes. Hip-fractured patients represent a significant and vulnerable group, and women comprise the majority of this population. Despite a developing research base, acute confusion remains poorly understood, and few studies have examined the experience of acute confusion from the perspective of the sufferer. This study used the four perspectives of the Human Response to Illness Model (Physiologic, Pathophysiologic, Behavioral, and Experiential) to explore the response of acute confusion in a group of five cognitively intact elderly hip-fractured women. The impact of person factors and environmental factors on the participants' responses was also considered. A case oriented, qualitative approach guided the study. Data was collected through participant observation and semi-structured interview. Three of the five participants developed acute confusion. The experiences of the two unaffected women were used for comparison and contrast. Despite the selection of a "homogenous" study population, findings illustrate the diverse and unique cognitive and behavioral responses of each individual to the hip-fracture experience. No single physiologic/pathophysiologic event could account for cognitive decline, and person factors and environmental factors impacted differently on each participant. Behavioral manifestations common to those with acute confusion included disengagement, disorganization, and disinhibition. Self report revealed feelings of fear and embarrassment. The study provides insights for practice, education and research. A repeated application of the study methodology using a larger population is recommended.