Influence of the coexistence of visual impairment, hearing impairment, and masticatory discomfort on the quality of life of middle-aged adults: an analysis based on the 2019 and 2020 Korea National He

Delirium, derived from the Latin term deliria, meaning “to go off the furrow,” refers to an acute and fluctuating disturbance in consciousness, orientation, memory, cognition, perception, and behavior []. This condition is frequently observed among patients in neurological intensive care units and occurs more frequently in older adults, post-surgical patients, and those with comorbid brain or chronic systemic conditions []. Early detection and timely management of delirium are crucial, as it is often reversible with appropriate intervention [,]. Older adults are particularly vulnerable to delirium due to diminished homeostatic regulation, sensory impairments, high prevalence of chronic illnesses, reduced resilience to acute stressors, sleep deprivation, and psychosocial stressors such as bereavement or social isolation []. Delirium in the elderly is often misdiagnosed as dementia or depression, leading to delayed treatment, which may result in stupor, coma, or even death in severe cases []. The pathophysiology of delirium involves disruptions in cerebral metabolism, decreased synthesis of acetylcholine, neurotransmitter imbalances, stress-related changes in brain metabolism, and right hemisphere dysfunction [,]. Neurotransmitter imbalances, particularly involving acetylcholine, dopamine, serotonin, gamma-amnionobutyric acid, glutamate, norepinephrine, opioids, somatostatin, beta-endorphin, and cortisol identified as key contributors to the development of delirium []. Delirium symptoms categorized into cognitive disturbances, psychiatric manifestations, sleep-wake cycle disruptions, and neurological abnormalities. These symptoms often intensify in the evening and tend to fluctuate significantly throughout the day [,,]. In elderly patients, delirium may manifest through disorientation and wandering behaviors, such as pulling out intravenous lines or attempting to leave the hospital room, which can lead to falls []. Moreover, delirium in older adults recognized as an independent risk factor for increased mortality []. South Korea has projected to become a super-aged society by 2025, with individuals aged 65 and older comprising over 20% of the population, and this figure is expected to exceed 40% by 2050 []. In response, the government has implemented an integrated nursing care (INC) model to alleviate caregiver burden and improve patient safety amid rising chronic disease prevalence and increased family satisfaction. This model allows professional nurses and nursing assistants to deliver comprehensive care in place of informal caregivers, thereby enhancing direct nursing time, improving patient satisfaction, and yielding better health outcomes []. With the progression toward an aging society, the hospitalization rate of elderly patients who are at elevated risk for delirium is steadily increasing [,]. INC wards, which allow patients to receive nursing services without a caregiver present, see a higher admission rate among older adults, as families seek to alleviate the burden of caregiving [,]. As such, this ward presents a high-risk environment for the development of delirium []. For nurses working in such settings, possessing sufficient knowledge about delirium is essential for the early recognition of symptoms and the provision of timely and appropriate interventions. This is particularly important because delirium is an acute mental status change that can deteriorate rapidly, requiring nurses to make accurate judgments and respond effectively based on a solid understanding of the condition []. Furthermore, nursing with delirium patients can be highly stressful for nurses due to unpredictable behaviors, aggression, and fluctuating levels of consciousness []. In addition, nurses in INC wards often face higher patient-to-nurse ratios and the absence of family caregivers, which results in greater occupational stress compared to their counterparts in general wards or intensive care units []. Most critically, the lack of epidemiological data on the incidence of delirium in INC wards and the absence of standardized criteria for classifying its severity mean that patients with delirium are admitted to these wards without specific restrictions, thereby increasing the demand for nursing care in this context []. To address this issue, the 2024 revision of the service guidelines introduced resolute units for critically ill patients with delirium [].