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Hospital use, institutionalisation and mortality associated with delirium.
Age Ageing 2010; 39(4):470-5AA

Abstract

BACKGROUND

Delirium is a disorder affecting consciousness, which gives rise to core clinical features and associated symptoms. Older patients are particularly prone, owing to higher rates of pre-existing cognitive impairment, frailty, co-morbidity and polypharmacy.

OBJECTIVES

The aim of this study was to investigate the hypotheses that delirium affects the most vulnerable older adults and is associated with long-term adverse health outcome.

METHODS

This prospective cohort study evaluated 278 medical patients aged > or = 75 years admitted acutely to a district general hospital in South Wales. Patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Assessments also included illness severity, preadmission cognition, co-morbidity and functional status. Patients were followed for 5 years to determine rates of institutionalisation and mortality. Number of days in hospital in the 4 years prior to and 5 years after index admission were recorded.

RESULTS

Delirium was detected in 103 patients and excluded in 175. Median time to death was 162 days (interquartile range 21-556) for those with delirium compared with 1,444 days (25% mortality 435 days, 75% mortality>5 years) for those without (P < 0.001). After adjusting for multiple confounders, delirium was associated with an increased risk of death (hazard ratio range 2.0-3.5; P < or = 0.002). Institutionalisation was higher in the first year following delirium (P = 0.03). While those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity, they did not spend more days in hospital in the 4 years prior to index admission.

CONCLUSIONS

Delirium is associated with high rates of institutionalisation and an increased risk of death up to 5 years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome.

Authors+Show Affiliations

Department of Geriatric Medicine, Cardiff University, Academic Centre, University Hospital Llandough, Penarth, South Wales, UK. eamonn.eeles2@wales.nhs.uk <eamonn.eeles2@wales.nhs.uk>No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20554540

Citation

Eeles, Eamonn M P., et al. "Hospital Use, Institutionalisation and Mortality Associated With Delirium." Age and Ageing, vol. 39, no. 4, 2010, pp. 470-5.
Eeles EM, Hubbard RE, White SV, et al. Hospital use, institutionalisation and mortality associated with delirium. Age Ageing. 2010;39(4):470-5.
Eeles, E. M., Hubbard, R. E., White, S. V., O'Mahony, M. S., Savva, G. M., & Bayer, A. J. (2010). Hospital use, institutionalisation and mortality associated with delirium. Age and Ageing, 39(4), pp. 470-5. doi:10.1093/ageing/afq052.
Eeles EM, et al. Hospital Use, Institutionalisation and Mortality Associated With Delirium. Age Ageing. 2010;39(4):470-5. PubMed PMID: 20554540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital use, institutionalisation and mortality associated with delirium. AU - Eeles,Eamonn M P, AU - Hubbard,Ruth E, AU - White,Susan V, AU - O'Mahony,M Sinead, AU - Savva,George M, AU - Bayer,Antony J, PY - 2010/6/18/entrez PY - 2010/6/18/pubmed PY - 2010/10/1/medline SP - 470 EP - 5 JF - Age and ageing JO - Age Ageing VL - 39 IS - 4 N2 - BACKGROUND: Delirium is a disorder affecting consciousness, which gives rise to core clinical features and associated symptoms. Older patients are particularly prone, owing to higher rates of pre-existing cognitive impairment, frailty, co-morbidity and polypharmacy. OBJECTIVES: The aim of this study was to investigate the hypotheses that delirium affects the most vulnerable older adults and is associated with long-term adverse health outcome. METHODS: This prospective cohort study evaluated 278 medical patients aged > or = 75 years admitted acutely to a district general hospital in South Wales. Patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Assessments also included illness severity, preadmission cognition, co-morbidity and functional status. Patients were followed for 5 years to determine rates of institutionalisation and mortality. Number of days in hospital in the 4 years prior to and 5 years after index admission were recorded. RESULTS: Delirium was detected in 103 patients and excluded in 175. Median time to death was 162 days (interquartile range 21-556) for those with delirium compared with 1,444 days (25% mortality 435 days, 75% mortality>5 years) for those without (P < 0.001). After adjusting for multiple confounders, delirium was associated with an increased risk of death (hazard ratio range 2.0-3.5; P < or = 0.002). Institutionalisation was higher in the first year following delirium (P = 0.03). While those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity, they did not spend more days in hospital in the 4 years prior to index admission. CONCLUSIONS: Delirium is associated with high rates of institutionalisation and an increased risk of death up to 5 years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome. SN - 1468-2834 UR - https://www.unboundmedicine.com/medline/citation/20554540/Hospital_use_institutionalisation_and_mortality_associated_with_delirium_ L2 - https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/afq052 DB - PRIME DP - Unbound Medicine ER -