Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults

Abstract

Background Current literature does not identify the significance of underlying cognitive impairment and delirium on older adults during and 30 days following acute care hospitalization. Objective Describe the incidence, risk factors, and outcomes associated with incident delirium superimposed on dementia. Design 24-month prospective cohort study Setting community hospital Patients 139 older adults (>65 years) with dementia Methods This prospective study followed patients daily during hospitalization and one month post-hospital. Main measures included dementia (Modified Blessed Dementia Rating Score, IQ CODE), daily mental status change, dementia stage/severity (Clinical Dementia Rating, Global Deterioration Scale), delirium (Confusion Assessment Method), and delirium severity (Delirium Rating Scale-Revised-98). All statistical analysis was performed using SAS 9.3 and significance with an alpha level of 0.05. Logistic regression, analysis of covariance or linear regression was performed controlling for age, gender and dementia stage. Results The overall incidence of new delirium was 32% (44/140). Those with delirium had a 25% short term mortality rate, increased length of stay and poorer function at discharge. At one month follow-up, subjects with delirium had greater functional decline. Males were more likely to develop delirium and for every one unit increase in dementia severity (Global Deterioration Scale), subjects were 1.5 times more likely to develop delirium. Conclusions Delirium prolongs hospitalization for persons with dementia. Thus, interventions to increase early detection of delirium have the potential to decrease the severity and duration of delirium and to prevent unnecessary suffering and costs from the complications of delirium and unnecessary readmissions to the hospital.

Factors associated with prolonged length of stay in older patients

“…Fick et al further identified that patients with delirium superimposed on dementia had a higher likelihood of delayed discharge from hospitals. (13) Among patients with dementia, caregiver support and burden (14) are important predictors of pLOS, just as poor nutritional status (15) is an important predictor for older adults. Expectedly, clinical factors, (16) such as the principal admitting diagnosis and burden of comorbidities, have been shown to be important.…”

Are Blood Transfusions Useful for Non-Specific Symptoms of Anemia in the Elderly?

“…Delirium, a clinical syndrome that is defined as inattention and acute cognitive dysfunction affects an estimated 14-56% of all hospitalized elderly patients [12][13][14][15][16][17][18]. At least 50% of geriatric patients hospitalized annually in the US develop complications secondary to delirium with a mortality rate between 25-33% [12,13].…”

“…At least 50% of geriatric patients hospitalized annually in the US develop complications secondary to delirium with a mortality rate between 25-33% [12,13].…”

“…Delirium is associated with worse outcomes, extended hospitalizations, higher costs, cognitive decline and increased mortality rates [12][13][14][15]. Some of the important risk factors for delirium in the elderly are dementia, male sex, high burden of comorbidities, certain medications, sensory impairment, sleep deprivation, metabolic derangements and pain [14].…”

Delirium em idosos hospitalizados: análise de características clínicas e prognóstico

“…Comparada com demência isolada, esta sobreposição está associada a custos mais elevados, declínio funcional mais acentuado e maior mortalidade 51,52 Program (HELP), um programa de prevenção de delirium e declínio funcional que já foi implementado em mais de 200 hospitais do mundo todo 20,80 . As estratégias voltadas para reorientar pacientes, promover atividades terapêuticas, reduzir uso e doses de medicações psicoativas, promover mobilização, garantir tempo de sono, e manter hidratação e nutrição, mostraram-se efetivas em seus objetivos, economizando, anualmente, até US$ 9 mil por paciente internado 81 .…”