The relationship between frailty and delirium: insights from the 2017 Delirium Day study

Abstract

Background although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients’ 30-day survival. Design observational study nested in the Delirium Day project, with 30-day follow-up. Setting acute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy. Subjects a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. Methods a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. Results overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45–1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41–1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27–2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33–2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28–2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. Conclusions in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality.

Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

“…Frailty is a geriatric condition characterized by increased vulnerability for adverse events. Many studies have demonstrated that frailty increases the risk of delirium underscoring the need for early screening of frailty in hospitalized patients [ 25 – 27 ]. The reason for this increased susceptibility is likely related to the pathophysiological link between frailty and delirium.…”

Association between frailty, delirium, and mortality in older critically ill patients: a binational registry study

“…In another study of patients (≥ 70 years) admitted to acute medical care, the overall impact of delirium on admission tends to be greater at lower levels of frailty (P = 0.07) [15]. A study of 2,065 patients aged 65 years or older hospitalized in 118 acute medical wards and 46 rehabilitation units in Italy found that there was no interaction between delirium and frailty on 30-day mortality (P = 0.477) [32]. The discrepant findings between studies may relate in part to variations in study populations, sample size, and tools for the assessment of frailty and delirium [6,33].…”

Delirium in Frail Older Adults

“…Eeles et al 45 ) assessed the impact of frailty on mortality among older inpatients who had delirium in a single-center study and reported that frail patients had greater long-term mortality among those with delirium compared with that among those without frailty—median survival of 88 days (95% CI, 5–171) for frail patients vs. 359 days (95% CI, 118–600) for fit patients. However, Mazzola et al 46 ) reported that delirium alone was not associated with mortality after adjusting for frailty, supporting the role of frailty as a confounder, increasing the vulnerability to stressors that lead to death. Dani et al 47 ) conducted a survival analysis to identify the impact of delirium on frailty in hospitalized older adults; interestingly, they reported an inverse gradient of association, with a stronger association observed in the fitter group and a higher hazard ratio for delirium in patients with a lower frailty index.…”

“…45 However, Mazzola et al reported that delirium alone did not show association with mortality after adjusting frailty, supporting the statement that frailty plays a role as a confounder, increasing the vulnerability to stressors that lead to death. 46 More interestingly, Dani et al conducted a survival analysis to identify the impact of delirium on frailty for hospitalized older adults and reported an inverse gradient of association, that stronger association were observed in the fitter group -patients with lower frailty index had a higher hazard ratio from delirium. 47 Besides the mortality as a clinical outcome, a single-center study by Ogawa et al assessed the impact of post-operative frailty on major adverse cardiac events after cardiac surgery.…”