Predisposing and Precipitating Factors for Delirium in the Very Old (≥80 Years): A Prospective Cohort Study of 3,076 Patients

Abstract

<b><i>Background:</i></b> Predisposing and precipitating factors for delirium for the elderly, over the age of 65 years, are known, but not for the very old, over 80 years. As the society is getting older and evermore patients will reach >80 years, more evidence of the factors and their contribution to delirium is required in this patient group. <b><i>Methods:</i></b> In the course of 1 year, 3,076 patients above 80 years were screened prospectively for delirium based on a Delirium Observation Screening (DOS) scale, Intensive Care Delirium Screening Checklist (ICDSC), and a DSM (Diagnostic and Statistical Manual)-5 nursing instrument (ePA-AC) construct. Relevant predisposing and precipitating factors for delirium were assessed with a multiple regression analysis. <b><i>Results:</i></b> Of 3,076 patients above 80 years, 1,285 (41.8%) developed a delirium, which led to twice prolonged hospitalization (<i>p</i> < 0.001), requirement for subsequent assisted living (OR 2.2, CI: 1.73–2.8, <i>p</i> < 0.001), and increased mortality (OR 24.88, CI: 13.75–45.03, <i>p</i> < 0.001). Relevant predisposing factors were dementia (OR 15.6, CI: 10.17–23.91, <i>p</i> < 0.001), pressure sores (OR 4.61, CI: 2.74–7.76, <i>p</i> < 0.001), and epilepsy (OR 3.65, CI: 2.12–6.28, <i>p</i> < 0.0001). Relevant precipitating factors were acute renal failure (4.96, CI: 2.38–10.3, <i>p</i> < 0.001), intracranial hemorrhage (OR 8.7, CI: 4.27–17.7, <i>p</i> < 0.001), and pleural effusions (OR 3.25, CI: 1.77–17.8, <i>p</i> < 0.001). <b><i>Conclusion:</i></b> Compared to the general delirium rate of approximately 20%, the prevalence of delirium doubled above the age of 80 years (41.8%) due to predisposing factors uncommon in younger patients.

Proteomics for the Discovery of Clinical Delirium Biomarkers: A Systematic Review of Major Studies

“…Given that interleukin-2 (IL-2), C-X-C motif chemokine 11, and C-C motif chemokine 13, 23–25 among others, were elevated preoperatively, it is equally likely that a heightened preoperative inflammatory state increased the risk of delirium, although functional studies would be required to rigorously test this hypothesis. This observation is consistent with prevailing knowledge that phenotypic delirium is a culmination of multiple predisposing and precipitating factors, 5,33,34 and predictive biomarkers may be more beneficial to certain risk groups than others.…”

“…1,2 Delirium is etiologically heterogeneous, with many precipitating and predisposing factors. [3][4][5] After surgery, it complicates geriatric hospitalizations with significant functional impairments, longer hospital stays, higher cost of care, and increased overall mortality risk. [6][7][8] Despite the substantial impact in this demographic, delirium is diagnosed through subjective assessment of a constellation of signs and symptoms within the clinical history, behavioral observation, and cognitive assessments.…”

Proteomics for the discovery of clinical delirium biomarkers: A systematic review of Major Studies

“…Given that IL-2, C-X-C motif chemokine 11 and C-C motif chemokine 13 23-25 , among others, were elevated preoperatively, it is equally likely that a heightened pre-operative inflammatory state increased the risk of delirium, although functional studies would be required to rigorously test this hypothesis. This observation is consistent with prevailing knowledge that phenotypic delirium is a culmination of multiple predisposing and precipitating factors 5,33,34 , and predictive biomarkers may be more beneficial in certain risk groups than others.…”

“…1,2 Delirium is etiologically heterogenous, with many precipitating and predisposing factors. [3][4][5] Following surgery, it complicates geriatric hospitalizations with significant functional impairments, longer hospital stays, higher cost of care and increased overall mortality risk. [6][7][8] Despite the substantial impact in this demographic, delirium is diagnosed through subjective assessment of a constellation of signs and symptoms within the clinical history, behavioral observation and cognitive assessments.…”

Pilot testing of a new electronic diagnostic support tool (AiD-DST) designed to identify the cause(s) of delirium

“…In a sample of 3,076 patients aged >80 years, 42% of whom developed delirium, renal failure, intracranial haemorrhage and pleural effusions were putative causes. 7 Even when the same patient conditions are studied, there is little replication in causality. 8 These associations also fail to encompass the diversity of potential causalities in any given patient where the multifactorial nature of the condition is the only reliable rule.…”