Patients admitted to postacute skilled nursing facilities with delirium are more likely to experience complications, rehospitalization, and death than patients without delirium. These findings support the need for improved case finding and management of delirium in postacute care.

OBJECTIVES-To examine the association between persistent delirium and one-year mortality in newly admitted delirious post-acute care (PAC) facility patients, who were followed regardless of residence. DESIGN-Observational cohort study. SETTING-Eight greater-Boston skilled nursing facilities specializing in PAC.PARTICIPANTS-Four hundred and twelve PAC patients with delirium at the time of admission after an acute hospitalization.MEASUREMENTS-Assessments were done at baseline and four follow-up times: 2-week, 4-week, 12-week and 26-week. "Confusion Assessment Method"-defined delirium was assessed, as were factors used as covariates in analyses including: age, gender, comorbidity, functional status and dementia. The outcome was one-year mortality determined by the National Death Index and corroborated by medical record, and proxy telephone interview.RESULTS-Nearly one-third remained delirious at 6 months. The cumulative one-year mortality was 39%. Independent of age, gender, comorbidity, functional status and dementia, subjects with persistent delirium were 2.9 (95% confidence interval, 1.9, 4.4) times more likely to die during the one-year follow-up compared to subjects who resolved their delirium. This association remained strong and significant in groups with and without dementia. Additionally, when delirium resolved, the risk of death diminished thereafter. DK Kiely -study concept and design, analysis and interpretation of data, and preparation of manuscript. ER Marcantonio -study concept and design, acquisition of subjects and/or data, interpretation of data, and preparation of manuscript. SK Inouye -study concept and design, interpretation of data, and preparation of manuscript. ML Shaffer -study concept and design, analysis and interpretation of data, and preparation of manuscript. MA Bergmann -study concept and design, acquisition of subjects and/or data, and preparation of manuscript. FM Yang -study concept and design, and preparation of manuscript. MA Fearing -study concept and design, and preparation of manuscript. RN Jones -study concept and design, analysis and interpretation of data, and preparation of manuscript. Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. CONCLUSION-Among patients who were delirious at the time of PAC admission and followed regardless of residence, persistent delirium was a significant independent predictor of one-year mortality. NIH Public Access