Delirium in Hospitalized Elderly Patients and Post-Discharge Mortality

Abstract

OBJECTIVE:To determine the impact of delirium on post-discharge mortality in hospitalized older patients.INTRODUCTION:Delirium is frequent in hospitalized older patients and correlates with high hospital mortality. There are only a few studies about its impact on post-discharge mortality.METHODS:This is a prospective study of patients over 60 years old who were hospitalized in the Geriatric Unit at Hospital das Clínicas of São Paulo between May 2006 and March 2007. Upon admission, demographics, comorbidities, number of drugs taken, and serum albumin concentration were evaluated for each patient. Delirium was diagnosed according to the DSM-IV criteria. Patients were divided into group A (with delirium) and group B (without delirium). One year after discharge, the patients or their caregivers were contacted to assess days of survival.RESULTS:The sample included 199 patients, 66 (33%) of whom developed delirium (Group A). After one year, 33 (50%) group A patients had died, and 45 (33.8%) group B patients had died (p = 0.03). There was a significant statistical difference in average age (p = 0.001) and immobility (p <0.001) between groups A and B. There were no statistically significant differences between groups A and B in number of drugs taken greater than four (p = 0.62), sex (p = 0.54) and number of diagnoses greater than four (p = 0.21). According to a multivariate analysis, delirium was not an independent predictor of post-discharge mortality. The predictors of post-discharge mortality were age ≥ 80 years (p = 0.029), albumin concentration < 3.5 g/dl (p = 0.001) and immobility (p = 0.007).CONCLUSION:Delirium is associated with higher post-discharge mortality as a dependent predictor.

Underdiagnosis of delirium in the elderly in acute care hospital settings: lessons not learned

“…The cognitive hallmark of delirium is loss of attention, whereas dementia, in general, involves disproportionate memory involvement, with fairly preserved attention . Delirium is associated with increased morbidity and mortality, need for close nursing supervision, increase in hospitalization costs, prolonged hospitalization, and increased rate of institutionalization after discharge …”

Association of education with occurrence of delirium in patients from an emergency department

“…26 Another investigation conducted in Brazil involving older patients (age >60 years) from hospital wards found a prevalence of 33%. 27 In the study for the validation of the Brazilian CAM, prevalence of delirium was between 10 and 24% in hospitalized patients. 13 …”

Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

“…Delirium , or an acute confusional picture, is frequent in patients aged older than 65 years, and is associated to increased mortality and morbidity. 40 , 41 Delirium is typically characterized by acute onset (hours or days) of change in conscience and cognitive and attentional decline which is oscillatory in nature, with alterations in perception (illusions, hallucinations), triggered by cerebral or systemic disease. The two forms of delirium are hypoactive and hyperactive.…”