Outcomes of Older People Admitted to Postacute Facilities with Delirium

Marcantonio, Edward R.; Kiely, Dan K.; Simon, Samuel; Orav, E. John; Jones, Richard N.; Murphy, Katharine M.; Bergmann, Margaret A.

doi:10.1111/j.1532-5415.2005.53305.x

Cited by 238 publications

(209 citation statements)

References 31 publications

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“…Improvements in survival to hospital discharge were documented across a broad range of demographic and clinical conditions and were not due to rising rates of discharge to SNF; short-term mortality in patients who were discharged to SNF would need to have exceeded 60% to challenge the conclusion that mortality rates that are associated with ARF and ARF-D have declined. The 60% figure is far in excess of mortality rates that have been reported in extended-care facilities for elderly patients with delirium (25% 6-mo mortality) (29) and critically ill surgical patients with Acute Physiology and Chronic Health Evaluation II scores Ն20 (approximately 22% 1-mo mortality, 50% 2-yr mortality) (30).…”

Section: Discussionmentioning

confidence: 86%

Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

Waikar

Curhan²,

Wald³

et al. 2006

Journal of the American Society of Nephrology

526

377

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Section: Discussionmentioning

confidence: 86%

Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

Waikar

Curhan²,

Wald³

et al. 2006

Journal of the American Society of Nephrology

526

377

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“…Few studies have assessed delirium in postacute care [25, 26], and, in addition, we are adding evidence on patients with particularly advanced age during an acute event, as well as on delirium in patients with dementia in this setting, with a relatively large sample. Dementia and age are widely recognized risk factors for delirium in older hospitalized patients, and our findings confirm previous results in other settings [13, 19, 27].…”

Section: Discussionmentioning

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

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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.

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“…Patients with core symptoms of delirium not reaching full syndromal criteria (sub-syndromal delirium) experience outcomes similar to those for the full syndromal illness (Marcantonio et al, 2005). Furthermore, studies comparing diagnostic schema support broader definitions of delirium (Laurila et al, 2004).…”

Section: The Complex Nature Of Deliriummentioning

confidence: 91%

The active management of delirium: improving detection and treatment

Meagher¹,

Leonard²

2008

Adv. psychiatr. treat

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The management of delirium requires careful consideration of the potential value both of pharmacological interventions and of a range of non-drug strategies. Although placebo-controlled studies of delirium treatment are lacking, less robust evidence can still inform practice. This review makes the case for more active management of delirium on the basis of recent studies of prevention, early identification and treatment both during an episode and managing the aftermath in survivors. A drug-treatment algorithm for delirium advising how drug treatments can be tailored to the specific needs of individual patients is described.

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Outcomes of Older People Admitted to Postacute Facilities with Delirium

Abstract: 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.

Cited by 238 publications

References 31 publications

Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002

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

The active management of delirium: improving detection and treatment

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