Delirium in nursing homes and long-term care facilities: findings of a scoping review of detection tools

Background: The detection of delirium among residents in nursing homes (NH) and long-term care (LTC) facilities remains challenging due to overlapping symptoms with dementia, limited staff training, and variability in assessment tools. This scoping review aimed to identify delirium detection tools and their properties as used for research purposes in these settings. Methods: The methodology was guided by Arksey and O'Malley and Levac et al. Medline, Embase, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched for original research studies. Results: A total of 58 studies met the inclusion criteria, with most conducted in the USA (37.9%) and Europe. We identified 25 delirium detection tools, with the Confusion Assessment Method long form (43.1%), the Neelon and Champagne Confusion Scale (10.3%), the Nursing Home Confusion Assessment Method (10.3%), the short Confusion Assessment Method and its modifications (8.6%), the Delirium Index (6.8%), the Delirium Rating Scale-Revised-98 (6.8%), and the 4A's Test (5.1%) as the most frequently used. Only 14 tools have undergone validity and reliability testing in NH/LTC settings, with the Delirium Observation Screening Scale showing the highest diagnostic accuracy. Ten tools showed full concordance regarding the three delirium domains: cognitive domain, higher-level thinking domain, and circadian domain. The Delirium Diagnostic Tool-Provisional (DDT-Pro) required no more than three items. Discussion: This review highlights the lack of standardized delirium detection in NH/LTC settings. Future research should focus on providing evidence based on validity and reliability of existing tools, integrating delirium screening and assessment into routine care as part of delirium prevention and management, and training NH/LTC staff.