Delirium superimposed on dementia in post-acute care: Nurse documentation of symptoms and interventions.

Nursing notes show what was written, not whether nurses recognized delirium or actually gave the intervention. Absence of a note does not prove that a symptom was not communicated or that an intervention was not done. The analysis did not collect data on nurse role, education, experience, resident to staff ratios, or unit type. It used paper charts in facilities without electronic health records, and only week one notes were reviewed. Two patients died or transferred before review, and two with incomplete data were excluded from regression, leaving 279 analysed for that part. The chart abstraction instrument was not perfect: sensitivity was 74%, specificity was 83%, and agreement with interviewer ratings was 82%, kappa 0.41. The sample was mostly female, Caucasian, and from rural Pennsylvania, so results may not apply to other settings. This is a secondary analysis of a parent trial, not a test of whether documentation changes outcomes.

The supplied article text does not include a conflicts-of-interest declaration. Publication metadata lists NIH extramural support.

Do not read 74% symptom charting as proof that delirium was recognized and managed. Charting does not guarantee recognition or intervention, and missing notes do not prove symptoms were not communicated or treated.