A framework of social determinants of health for delirium tailored to older adults

Arias, Franchesca; Alegrı́a, Margarita; Kind, Amy; Jones, Richard N.; Travison, Thomas G.; Marcantonio, Edward R.; Schmitt, Eva M.; Fong, Tamara G.; Inouye, Sharon K.

doi:10.1111/jgs.17465

Cited by 13 publications

(15 citation statements)

References 68 publications

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“… Arias et al (2022) have proposed a novel conceptual framework for the impact of social determinants of health on delirium. This framework is based on the premise that environmental and social factors may increase risk for delirium by influences that increase brain vulnerability across the life course.…”

Section: Background and Objectivesmentioning

confidence: 99%

“…These studies found that early socioeconomic disadvantage was significantly associated with cognitive difficulty in middle and late life ( Fors et al, 2009; Greenfield & Moorman, 2019 ). This study addresses an important gap in the literature, as the association between childhood SES and acute changes in cognition has not been systematically investigated ( Arias et al, 2022 ). Given that delirium is a preventable risk factor for subsequent cognitive decline, understanding the contribution of early exposures to delirium may assist with developing interventions that can potentially alter cognitive trajectories ( Fong et al, 2009 ).…”

Section: Background and Objectivesmentioning

confidence: 99%

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Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures

Shiff

Arias

Dufour

et al. 2022

Innovation in Aging

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Background and Objectives Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later life delirium. In this study, we explored the association between paternal occupation and delirium risk. Research Design and Methods A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue-collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay. Results Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR [95% confidence interval, CI] = 1.6 [1.1, 2.3]. All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index (CCI). Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared to white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 [95% CI, 0.4, 1.4] additional severity units. Discussion and Implications Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life course framework to evaluate the risk of later life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.

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Section: Background and Objectivesmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures

Shiff

Arias

Dufour

et al. 2022

Innovation in Aging

Self Cite

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“…However, the enrollment of Black or African American participants (28 [5%]) exceeded expectations given US Census data (4%). Moreover, SAGES is well represented with other important social determinants of health, including neighborhood disadvantage and low income levels . Importantly, information on amyloid status from cerebrospinal fluid biomarkers or amyloid imaging was not available in this cohort; thus, the associations of these variables with cognitive trajectory could not be evaluated.…”

Section: Discussionmentioning

confidence: 98%

Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium

et al. 2023

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ImportanceThe study results suggest that delirium is the most common postoperative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia.ObjectiveTo examine the patterns and pace of cognitive decline up to 72 months (6 years) in a cohort of older adults following delirium.Design, Setting, and ParticipantsThis was a prospective, observational cohort study with long-term follow-up including 560 community-dwelling older adults (older than 70 years) in the ongoing Successful Aging after Elective Surgery study that began in 2010. The data were analyzed from 2021 to 2022.ExposureDevelopment of incident delirium following major elective surgery.Main Outcomes and MeasuresDelirium was assessed daily during hospitalization using the Confusion Assessment Method, which was supplemented with medical record review. Cognitive performance using a comprehensive battery of neuropsychological tests was assessed preoperatively and across multiple points postoperatively to 72 months of follow-up. We evaluated longitudinal cognitive change using a composite measure of neuropsychological performance called the general cognitive performance (GCP), which is scaled so that 10 points on the GCP is equivalent to 1 population SD. Retest effects were adjusted using cognitive test results in a nonsurgical comparison group.ResultsThe 560 participants (326 women [58%]; mean [SD] age, 76.7 [5.2] years) provided a total of 2637 person-years of follow-up. One hundred thirty-four participants (24%) developed postoperative delirium. Cognitive change following surgery was complex: we found evidence for differences in acute, post–short-term, intermediate, and longer-term change from the time of surgery that were associated with the development of postoperative delirium. Long-term cognitive change, which was adjusted for practice and recovery effects, occurred at a pace of about −1.0 GCP units (95% CI, −1.1 to −0.9) per year (about 0.10 population SD units per year). Participants with delirium showed significantly faster long-term cognitive change with an additional −0.4 GCP units (95% CI, −0.1 to −0.7) or −1.4 units per year (about 0.14 population SD units per year).Conclusions and RelevanceThis cohort study found that delirium was associated with a 40% acceleration in the slope of cognitive decline out to 72 months following elective surgery. Because this is an observational study, we cannot be sure whether delirium directly causes subsequent cognitive decline, or whether patients with preclinical brain disease are more likely to develop delirium. Future research is needed to understand the causal pathway between delirium and cognitive decline.

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“…In this context, it would be tempting to speculate whether these social determinants played any role in the susceptibility of Brazilian women to delirium. However, the matter is still understudied [ 44 , 45 ], and even education level, an important risk factor for dementia, is not properly considered in the delirium literature [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological manifestations by sex and age group in COVID-19 inhospital patients

et al. 2022

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A framework of social determinants of health for delirium tailored to older adults

Cited by 13 publications

References 68 publications

Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures

Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures

Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium

Neurological manifestations by sex and age group in COVID-19 inhospital patients

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