Impact of Delirium on Mortality and Cognitive and Functional Performance Among Elderly People With Femoral Fractures

Abstract

Furlaneto ME, Garcez-Leme LE. Impact of delirium on mortality and cognitive and functional performance among elderly people with femoral fractures. Clinics. 2007;62(5):545-52. OBJECTIVE:To evaluate the evolution of cognitive and functional performance and mortality among elderly patients who were delirious during hospitalization due to femoral fracture. who did not present with delirium. There were six deaths, and 97 patients were discharged from the hospital. We obtained information on 85 of these patients four years after discharge; 42 patients were still alive and 43 had died at the time of the evaluation. METHODS: Data on vital status was obtained for 85 patients. For the 42 survivors, we acquired information on their basic activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive performance (BDRS) by means of telephone interview with the same caregivers who had provided information at the time of the hospitalization. We compared this data with that obtained during their hospitalizations four years prior. For the 43 patients who died, we obtained information regarding their deaths and used this data in the analysis of mortality. RESULTS: No relationships were observed between delirium and mortality, delirium and cognitive loss, or delirium and functional loss, after four years from discharge of elderly patients with hip fractures. An initial cognitive deficit was a predictor for mortality (RR = 2.54; p = 0.016), functional loss (OR = 1.80; p = 0.027) and cognitive loss (OR = 1.53; p = 0.024). Cognitive loss was also related to age. CONCLUSIONS: Delirium had no impact on mortality or functional or cognitive losses in long term evolution (2 years) among elderly patients with femoral fractures. An initial cognitive impairment may identify patients at risk of mortality, functional and cognitive losses over the long term evolution.

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

“…Functional status before fracture, older age, male gender, and higher surgical risk increased the risk of mortality, whereas the use of antibiotics and physical therapy after surgery decreased the risk. Previous studies showed functional status before fracture [14,42,45,52], male gender [12,15,28,33,36,42,47], older age [10,15,28,36,43,47,50,52,55], and higher ASA scores predicted mortality in older patients [24,26,33,44,49] (Table 3), which is in agreement with our findings. In our study, we did not see a difference in mortality between patients undergoing arthroplasty versus patients undergoing osteosynthesis, which is in agreement with mortality reported by Garcia et al [15] and others [18,33,37].…”

“…It has been suggested the reason for this increased mortality after arthroplasty could be higher use of arthroplasty with older age, but so far the evidence is inconclusive [18,54]. Finally, many authors have reported the impact of comorbid conditions on mortality [10,12,14,28,36,37,42,46,47,[50][51][52], whereas we did not observe this. This might be attributable to our measurement of comorbid conditions.…”

Cognitive Trajectories after Postoperative Delirium

“…This study establishes an association between delirium after cardiac surgery and cognitive dysfunction by means of preoperative and serial objective assessments of cognitive function and state-of-the-art assessments of delirium, both of which were not, to our knowledge, used in previous studies. [33][34][35][36][37][38] With the aging of the patient population undergoing cardiac surgery and increases in survival after surgery, clinicians and patients are increasingly concerned with factors associated with quality of life, including cognitive status, as major outcomes of surgery. 11,15 Although a high proportion of patients undergoing cardiac surgery have cognitive impairment immediately after the surgery, impairment diminishes in the weeks and months after discharge.…”

Cirurgia ortopédica em idosos: aspectos clínicos

“…Evaluation of the red series is very important among elderly people (18) . Relatively small impro- non-coronary disease patients is recommended, but attentiveness must be maintained since elderly people may present silent ischemia.…”

“…Delirium is a frequent complication during the postoperative period (18,22) . Approximately 30% of According to the DSM-IV, delirium is characterized by altered consciousness, difficulty in focusing attention, cognitive impairment and disorganized thinking, and it may be associated with perception disorders.…”