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Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study.
CMAJ 2001; 165(5):575-83CMAJ

Abstract

BACKGROUND

Delirium in older hospital inpatients appears to be associated with various adverse outcomes. The limitations of previous research on this association have included small sample sizes, short follow-up periods and lack of consideration of important confounders or modifiers, such as severity of illness, comorbidity and dementia. The objective of this study was to determine the prognostic significance of delirium, with or without dementia, for cognitive and functional status during the 12 months after hospital admission, independent of premorbid function, comorbidity, severity of illness and other potentially confounding variables.

METHODS

Patients 65 years of age and older who were admitted from the emergency department to the medical services were screened for delirium during their first week in hospital. Two cohorts were enrolled: patients with prevalent or incident delirium and patients without delirium, but similar in age and cognitive impairment. The patients were followed up at 2, 6 and 12 months after hospital admission. Analyses were conducted for 4 patient groups: 56 with delirium, 53 with dementia, 164 with both conditions and 42 with neither. Baseline measures included delirium (Confusion Assessment Method), dementia (Informant Questionnaire on Cognitive Decline in the Elderly), physical function (Barthel Index [BI] and premorbid instrumental activities of daily living, IADL), the Mini-Mental State Examination (MMSE), comorbidity, and physiologic and clinical severity of illness. Outcome variables measured at follow-up were the MMSe, Barthel Index, IADL and admission to a long-term care facility.

RESULTS

After adjustment for covariates, the mean differences in MMSE scores at follow-up between patients with and without delirium were -4.99 (95% confidence interval [CI] -7.17 to -2.81) for patients with dementia and -3.36 (95% CI -6.15 to -0.58) for those without dementia. At 12 months, the adjusted mean differences in the BI were -16.45 (95% CI -27.42 to -5.50) and -13.89 (95% CI -28.39 to 0.61) for patients with and without dementia respectively. Patients with both delirium and dementia were more likely to be admitted to long-term care than those with neither condition (adjusted odds ratio 3.18, 95% CI 1.19 to 8.49). Dementia but not delirium predicted worse IADL scores at follow-up. Unadjusted analyses yielded similar results.

INTERPRETATION

For older patients with and without dementia, delirium is an independent predictor of sustained poor cognitive and functional status during the year after a medical admission to hospital.

Authors+Show Affiliations

Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Department of Epidemiology and Biostatistics, McGill University, Montreal, Que. jane.mccusker@mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11563209

Citation

McCusker, J, et al. "Delirium in Older Medical Inpatients and Subsequent Cognitive and Functional Status: a Prospective Study." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 165, no. 5, 2001, pp. 575-83.
McCusker J, Cole M, Dendukuri N, et al. Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ. 2001;165(5):575-83.
McCusker, J., Cole, M., Dendukuri, N., Belzile, E., & Primeau, F. (2001). Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 165(5), pp. 575-83.
McCusker J, et al. Delirium in Older Medical Inpatients and Subsequent Cognitive and Functional Status: a Prospective Study. CMAJ. 2001 Sep 4;165(5):575-83. PubMed PMID: 11563209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. AU - McCusker,J, AU - Cole,M, AU - Dendukuri,N, AU - Belzile,E, AU - Primeau,F, PY - 2001/9/21/pubmed PY - 2001/10/19/medline PY - 2001/9/21/entrez SP - 575 EP - 83 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 165 IS - 5 N2 - BACKGROUND: Delirium in older hospital inpatients appears to be associated with various adverse outcomes. The limitations of previous research on this association have included small sample sizes, short follow-up periods and lack of consideration of important confounders or modifiers, such as severity of illness, comorbidity and dementia. The objective of this study was to determine the prognostic significance of delirium, with or without dementia, for cognitive and functional status during the 12 months after hospital admission, independent of premorbid function, comorbidity, severity of illness and other potentially confounding variables. METHODS: Patients 65 years of age and older who were admitted from the emergency department to the medical services were screened for delirium during their first week in hospital. Two cohorts were enrolled: patients with prevalent or incident delirium and patients without delirium, but similar in age and cognitive impairment. The patients were followed up at 2, 6 and 12 months after hospital admission. Analyses were conducted for 4 patient groups: 56 with delirium, 53 with dementia, 164 with both conditions and 42 with neither. Baseline measures included delirium (Confusion Assessment Method), dementia (Informant Questionnaire on Cognitive Decline in the Elderly), physical function (Barthel Index [BI] and premorbid instrumental activities of daily living, IADL), the Mini-Mental State Examination (MMSE), comorbidity, and physiologic and clinical severity of illness. Outcome variables measured at follow-up were the MMSe, Barthel Index, IADL and admission to a long-term care facility. RESULTS: After adjustment for covariates, the mean differences in MMSE scores at follow-up between patients with and without delirium were -4.99 (95% confidence interval [CI] -7.17 to -2.81) for patients with dementia and -3.36 (95% CI -6.15 to -0.58) for those without dementia. At 12 months, the adjusted mean differences in the BI were -16.45 (95% CI -27.42 to -5.50) and -13.89 (95% CI -28.39 to 0.61) for patients with and without dementia respectively. Patients with both delirium and dementia were more likely to be admitted to long-term care than those with neither condition (adjusted odds ratio 3.18, 95% CI 1.19 to 8.49). Dementia but not delirium predicted worse IADL scores at follow-up. Unadjusted analyses yielded similar results. INTERPRETATION: For older patients with and without dementia, delirium is an independent predictor of sustained poor cognitive and functional status during the year after a medical admission to hospital. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/11563209/Delirium_in_older_medical_inpatients_and_subsequent_cognitive_and_functional_status:_a_prospective_study_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=11563209 DB - PRIME DP - Unbound Medicine ER -