Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease

Fong, Tamara G.; Jones, Richard N.; Marcantonio, Edward R.; Tommet, Douglas; Gross, Alden L.; Habtemariam, Daniel; Schmitt, Eva M.; Yap, Liang; Inouye, Sharon K.

doi:10.7326/0003-4819-156-12-201206190-00005

Cited by 198 publications

(156 citation statements)

References 30 publications

Supporting

Mentioning

145

Contrasting

Unclassified

Order By: Relevance

“…Among factors predisposing to delirium, dementia appears to be the most consistent in hospitalized patients [13, 14], and the prevalence of delirium superimposed on dementia (DSD) is almost 90% in some hospital-based studies [15-17]. Patients who develop DSD have an increased risk of longer hospital stay, morbidity, acceleration of cognitive and functional decline, institutionalization, and mortality [18-20]. …”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Gual

Morandi

Pérez

et al. 2018

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Background: Delirium research is poorly studied in postacute care, a growing setting due to aging populations, as well as in dementia, a critical risk factor for delirium and particularly prevalent in postacute care. We investigated risk factors for delirium and its outcomes in older adults with and without dementia admitted to a subacute care unit (SCU) after exacerbated chronic conditions. Methods: This is a prospective cohort study including patients ≥65 years old admitted to an SCU for 12 months. We collected demographics, comprehensive geriatric assessments, and presence of dementia and delirium at admission. Outcomes included discharge to previous living situation, mortality, and functional evolution. Due to the high prevalence of dementia, a subgroup analysis was performed to investigate specific risk factors for delirium and related outcomes. Results: Of 909 patients (mean age [±SD] 85.8 ± 6.7; 60% women, 47.5% with dementia), 352 (38.7%) developed delirium. The main risk factor for delirium was dementia (HR [95% CI] 5.2 [3.5–7.7]); age, functional status, and urinary tract infections were also independently associated with delirium. In dementia patients, only age (HR [95% CI] 1.0 [1.004–1.1]) and being male (HR [95% CI] 1.7 [1.04–2.6]) were associated with delirium. Delirium was associated with greater mortality (10.8 vs. 3.9%; p < 0.001) and greater functional decline in the entire sample (–12.3 vs. –6.4 Barthel index points; p < 0.001). In the dementia subgroup, patients with delirium experienced greater functional loss (p = 0.013) and less functional recovery (p = 0.025). Conclusions: In older patients admitted to postacute care, dementia is the main risk factor for delirium, and delirium carries worse clinical and functional outcomes. In patients with dementia, delirium is also relevant, since it entails a functional loss at admission and lower functional recovery.

show abstract

Section: Introductionmentioning

confidence: 99%

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Gual

Morandi

Pérez

et al. 2018

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

show abstract

“…Demented patients in general have a higher rate of post-operative complications and re-hospitalization, and may be less compliant with post-operative wound care, potentially increasing the incidence of skin irritation, infection, poor wound healing, or DBS malfunction [28][29][30]. In light of this, we tested our 5-year model with a doubled rate of surgical complication, well outside its 95 % CI.…”

Section: Discussionmentioning

confidence: 99%

Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis

et al. 2015

View full text Add to dashboard Cite

Alzheimer disease (AD) is characterized by impairments in memory function. Standard AD treatment provides marginal improvements in this domain. Recent reports, however, suggested that deep brain stimulation (DBS) may result in improved memory. Given significant equipment costs and health expenses required for DBS surgery, we determine clinical and economic thresholds required for it to be as effective as standard AD treatment. Literature review yielded annual AD progression probabilities, health-related quality of life (QoL), and costs by AD stage. Our 5-year decision analysis model compared cumulative QoL in quality-adjusted life years (QALYs) and costs of standard therapy to theoretical DBS treatment of various success rates, using known complication rates and QoL data. The base case was a patient with mild-stage AD. DBS success was defined as regression to and maintenance of minimal stage AD, which was defined as midway between mild and no dementia, for the first year, and continuation of the natural course of AD for the remaining 4 years. Compared to standard treatment alone, DBS for mild-stage AD requires a success rate of 3% to overcome effects of possible surgical complications on QoL. If DBS can be delivered with success rates above 20% ($200 K/QALY) or 74% ($50 K/QALY) for mild AD, it can be considered cost-effective. Above a success rate of 80%, DBS treatment is both clinically more effective and more cost-effective than standard treatment. Our findings demonstrate that clinical and economic thresholds required for DBS to be cost-effective for AD are relatively low.

show abstract

“…[4][5][6] Recent data suggest long-term effects of delirium including cognitive impairments up to 1 year following the illness 7 and an increased likelihood of developing 8 or worsening dementia. 9 It is estimated that one-third of hospital-acquired delirium cases could be prevented with appropriate interventions. 10 A prediction rule that easily and accurately identifies high-risk patients upon admission could therefore have a substantial clinical impact.…”

Section: Discussionmentioning

confidence: 99%

The AWOL tool: Derivation and validation of a delirium prediction rule

Douglas

Hessler

Dhaliwal

et al. 2013

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND Risk factors for delirium are well‐described, yet there is no widely used tool to predict the development of delirium upon admission in hospitalized medical patients. OBJECTIVE To develop and validate a tool to predict the likelihood of developing delirium during hospitalization. DESIGN Prospective cohort study with derivation (May 2010–November 2010) and validation (October 2011–March 2012) cohorts. SETTING Two academic medical centers and 1 Veterans Affairs medical center. PATIENTS Consecutive medical inpatients (209 in the derivation and 165 in the validation cohort) over age 50 years without delirium at the time of admission. MEASUREMENTS Delirium assessed daily for up to 6 days using the Confusion Assessment Method. RESULTS The AWOL prediction rule was derived by assigning 1 point to each of 4 items assessed upon enrollment that were independently associated with the development of delirium (Age ≥ 80 years, failure to spell “World” backward, disOrientation to place, and higher nurse‐rated iLlness severity). Higher scores were associated with higher rates of delirium in the derivation and validation cohorts (P for trend < 0.001 and 0.025, respectively). Rates of delirium according to score in the combined population were: 0(1/50, 2%), 1(5/141, 4%), 2(15/107, 14%), 3(10/50, 20%), and 4(7/11, 64%) (P for trend < 0.001). Area under the receiver operating characteristic curve for the derivation and validation cohorts was 0.81 (0.73–0.90) and 0.69 (0.54–0.83) respectively. CONCLUSIONS The AWOL prediction rule characterizes medical patients' risk for delirium at the time of hospital admission and could be used for clinical stratification and in trials of delirium prevention. Journal of Hospital Medicine 2013;8:493–499. © 2013 Society of Hospital Medicine

show abstract

Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease

Cited by 198 publications

References 30 publications

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis

The AWOL tool: Derivation and validation of a delirium prediction rule

Contact Info

Product

Resources

About