Does delirium contribute to poor hospital outcomes?

Abstract

OBJECTIVE:To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline. DESIGN:Three prospective cohort studies. SETTING: Three university-affiliated teaching hospitals.PATIENTS: Consecutive samples of 727 patients, aged 65 years and older. MEASUREMENTS AND MAIN RESULTS: Delirium, defined as an acute disorder of attention and global cognitive functioning, has assumed increasing importance in the United States, with the burgeoning population of older citizens. In 1993, 35% of the population aged 65 years and older was hospitalized during the year, accounting for 36% of all hospital stays and 48% of all days of hospital care. 1 The oldest group ( Ͼ 75 years) is the most rapidly growing sector of the U.S. population, 1 and is particularly vulnerable to developing delirium during acute illness and hospitalization. 2 Previous studies have estimated that delirium occurs in 14% to 56% of elderly hospitalized patients, with associated hospital mortality rates of 10% to 65%. 2 Previous studies have documented that delirium is associated with poor outcomes, such as increased mortality rates, prolonged length of hospital stay, increased rates of institutional placement, and functional and cognitive decline. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, the unanswered question remains: Does delirium itself contribute to this poor prognosis, or does delirium simply serve as a marker identifying patients with poor prognostic features due to severe illness, dementia, functional impairment, advanced age, and the like? Unfortunately, many of the previous studies, which were not all designed to address this research question directly, were hindered by inadequate control for these potential confounders and by small numbers of relatively infrequent outcome events.The objective of the present study was to examine the independent contribution of baseline delirium to hospital mortality, institutionalization, functional decline, and length of stay in three large prospective cohort studies of elderly hospitalized patients. 20 Uniform prospective data collection for this project facilitated collection of standardized information on delirium, study outcomes, and potential confounders. Our underlying hypothesis was that baseline delirium (present at admission) would be an important prognostic predictor even after controlling for underlying illness severity, age, dementia and functional status.

Use of Femoral Nerve Blocks to Manage Hip Fracture Pain among Older Adults in the Emergency Department: A Systematic Review

“…5 The prevalence of delirium amongst hip fracture patients has been shown to range from 13% to 61% 6 Furthermore, the occurrence of delirium has been shown to increase the incidence of adverse outcomes post fracture, including functional decline, permanent cognitive impairment, and death. [7][8][9][10][11] These data highlight the acute need for alternative methods of pain management in elderly patients suffering from hip fracture.…”

Meta‐analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population

“…Where resources are limited, it appears most reasonable to focus on major risk factors for inpatient falls that have independently been shown to be detrimental to outcomes, such as delirium. 51 Additionally, using inpatient fall rates as a hospital quality measure may be premature, given the lack of proven efforts to lower fall rates. Multidisciplinary fall prevention efforts on acutely ill inpatients should be further studied using high-quality, randomized trials.…”

Impact of Delirium on Mortality and Cognitive and Functional Performance Among Elderly People With Femoral Fractures

“…3 Several studies have found associations between the presence of delirium and a poor prognosis for functional recovery, increased mortality, increased length of hospital stay, increased institutionalization following discharge, and increased incidence of dementia. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In the present study, we re-evaluated patients, assessed during their hospitalization due to femoral fracture, four years after discharge. Groups with and without delirium were compared in terms of mortality and functional and cognitive evolution.…”