Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients

Abstract

Background: In an ever-aging society, health care systems will be confronted with an increasing number of patients over 80 years (“the very old”). Currently, knowledge about and recommendations for delirium management are often based on studies in patients aged 60 to 65 years. It is not clear whether these findings apply to patients ≥80 years.Aim: Comparison of younger and older patients with delirium, especially regarding risk factors.Methods: In this prospective cohort study, within 1-year, 5,831 patients (18–80 years: n = 4,730; ≥80: n = 1,101) with delirium were enrolled. The diagnosis of delirium was based on the Delirium Observation screening scale (DOS), Intensive Care Delirium Screening Checklist (ICDSC) and a DSM (Diagnostic and Statistical Manual)-5 construct of nursing instrument. Sociodemographic trajectories, as well as the relevant predisposing and precipitating factors for delirium, were assessed via a multiple regression analysis.Results: The very old were more commonly admitted as emergencies (OR 1.42), had a greater mortality risk (OR 1.56) and displayed fewer precipitating risk factors for the development of a delirium, although the number of diagnoses were not different (p = 0.325). Predisposing factors were sufficient almost alone for the development of delirium in patients ≥ 80 years of age; in 18–80 years of age, additional precipitating factors had to occur to make a delirium possible.Conclusion: When relevant predisposing factors for delirium are apparent, patients over 80 years of age require comparatively few or no precipitating factors to develop delirium. This finding should be taken into account at hospitalization and may allow better treatment of delirium in the future.

Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review

“…A study using the DOSS in patients aged ≥18 found a positive score rate of 28% 37 . Two studies used the DOSS combined with the ICDSC and the ePA‐AC, and reported an overall positive score rate of 42% in patients aged ≥80 years, 36 and 12% in surgical patients and 27% in medical patients aged ≥18 years 38 . A study using either the DOSS (non‐ICU) or ICDSC (ICU) in patients aged ≥65 reported an overall positive score rate of 32% 32 .…”

“…Some studies reported on all inpatients aged ≥18 years, 12,[17][18][19]37,38 whereas one study only included the oldest old. 36 Some studies reported single assessments (prevalent delirium), and others repeated assessments during the inpatient stay (a combination of prevalent and incident delirium). Estimation of real-world sensitivity of the tools for delirium detection, reflecting concordance between positive score and true delirium occurrence rates, could only be done indirectly for all but one study.…”

Quality Improvement in Delirium Health Literacy in Older Adult Patients and Their Caregivers Attending a Geriatric Clinic

“…It is predicted that in the near future the estimated cost of care for delirium could exhaust the resources of health-care systems. 8,[21][22][23] Not incorporating delirium awareness programs could result in a lack of knowledge about this disease and complicate its clinical outcomes. 9 Helping older patients and caregivers understand the risk factors associated with this disease can also aid in its timely management.…”

A Machine Learning Approach for Investigating Delirium as a Multifactorial Syndrome

“…In literature, risk factors for delirium were evaluated in systematic reviews according to the type of patients. Risk of delirium is higher in very old patients [ 5 , 6 ]. Marquetand et al 2020 [ 6 ] in a recent work found that very old patients require only few precipitant factors to develop delirium.…”

“…Risk of delirium is higher in very old patients [ 5 , 6 ]. Marquetand et al 2020 [ 6 ] in a recent work found that very old patients require only few precipitant factors to develop delirium. Age was a risk factor also for patients after hip fracture surgery [ 7 ], vascular surgery [ 8 ], in knee and hip replacement patients [ 9 ].…”