Predisposing and Precipitating Risk Factors for Delirium in Elderly Patients Admitted to a Cardiology Ward: An Observational Cohort Study in 1,042 Patients

Abstract

Aim: Although the risk factors for delirium in general medicine are well-established, their significance in cardiac diseases remains to be determined. Therefore, we evaluated the predisposing and precipitating risk factors in patients hospitalized with acute and chronic heart disease.Methods and Results: In this observational cohort study, 1,042 elderly patients (≥65 years) admitted to cardiology wards, 167 with and 875 without delirium, were included. The relevant sociodemographic and cardiac- and medical-related clusters were assessed by simple and multiple regression analyses and prediction models evaluating their association with delirium. The prevalence of delirium was 16.0%. The delirious patients were older (mean 80 vs. 76 years; p < 0.001) and more often institutionalized prior to admission (3.6 vs. 1.4%, p = 0.05), hospitalized twice as long (12 ± 10 days vs. 7 ± 7 days; p < 0.001), and discharged more often to nursing homes (4.8 vs. 0.6%, p < 0.001) or deceased (OR, 2.99; 95% CI, 1.53–5.85; p = 0.003). The most relevant risk factor was dementia (OR, 18.11; 95% CI, 5.77–56.83; p < 0.001), followed by history of stroke (OR, 6.61; 95% CI 1.35–32.44; p = 0.020), and pressure ulcers (OR, 3.62; 95% CI, 1.06–12.35; p = 0.040). The predicted probability for developing delirium was highest in patients with reduced mobility and institutionalization prior to admission (PP = 31.2%, p = 0.001). Of the cardiac diseases, only valvular heart disease (OR, 1.57; 95% CI, 1.01–2.44; p = 0.044) significantly predicted delirium. The patients undergoing cardiac interventions did not have higher rates of delirium (OR, 1.39; 95% CI 0.91–2.12; p = 0.124).Conclusion: In patients admitted to a cardiology ward, age-related functional and cognitive impairment, history of stroke, and pressure ulcers were the most relevant risk factors for delirium. With regards to specific cardiological factors, only valvular heart disease was associated with risk for delirium. Knowing these factors can help cardiologists to facilitate the early detection and management of delirium.

Predisposing and precipitating risk factors for delirium in gastroenterology and hepatology: Subgroup analysis of 718 patients from a hospital-wide prospective cohort study

“…Across most hospital populations, higher age is considered a main predisposing factor for delirium ( 9 ). In previous subgroup analyses from the same cohort, we found that age was a relevant predisposing in patients admitted to cardiology ( 25 ), neurology ( 12 ), and neurosurgery ( 13 ). By contrast, in our subgroups from stroke unit ( 11 ) and trauma care ( 26 ), similar to the presented GI- and HPB- cohort, age alone was not a relevant predisposing factor.…”

A simple risk score list can be used to predict the occurrence of delirium in patients admitted to inpatient hospice care: A medical record study

“…This was decided from a clinical point of view to be more accurate in using preventive measures and further screening instruments. The four items on the RSL‐4 have previously been identified as most predisposing factors for developing delirium (Guo et al, 2021 ; Zipser et al, 2021 ). Scoring the RSL‐4 could decrease the time spend on further screening for delirium, since we suggest to not use the DOS for patients identified as low risk.…”

Exploring the Pathophysiology of Delirium: An Overview of Biomarker Studies, Animal Models, and Tissue-Engineered Models

“…Examples of predisposing risk factors include advanced age, cognitive impairment, sensory deficits, history of stroke, and neuropsychiatric disorders. [2][3][4] Increased age is the most common predisposing risk factor for the development of delirium, particularly following invasive procedures or severe illness. 5 Precipitating risk factors include critical illness, infection, substance or medication use or withdrawal, hypoxia, metabolic depletion, physical restraints, and perioperative stressors.…”