Association Between Delirium Resolution and Functional Recovery Among Newly Admitted Postacute Facility Patients

Kiely, Dan K.; Jones, Richard N.; Bergmann, Margaret A.; Murphy, Katharine M.; Orav, E. John; Marcantonio, Edward R.

doi:10.1093/gerona/61.2.204

Cited by 94 publications

(94 citation statements)

References 22 publications

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“…These patterns fit biologically with the roles of IL-2 as an immune primer, and IL-6 as a marker of the acute inflammatory response. If confirmed, these cytokine patterns may be used to identify patients at greatest risk for developing delirium, to assist with delirium diagnosis, and to develop interventional strategies to reduce the impact of this common, morbid, and costly syndrome (28).…”

Section: Discussionmentioning

confidence: 99%

F3‐01‐01: Cytokines and postoperative delirium in older patients undergoing major elective surgery

Vasunilashorn

Marcantonio

2015

Alzheimer's & Dementia

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Background: A proinflammatory state has been associated with several age-associated conditions; however, the inflammatory mechanisms of delirium remain poorly characterized. Methods: Using the Successful Aging after Elective Surgery Study of adults age ≥70 undergoing major noncardiac surgery, 12 cytokines were measured at four timepoints: preoperative, postanesthesia care unit, postoperative day 2 (POD2) and 30 days later (POD1M). We conducted a nested, longitudinal matched (on age, sex, surgery type, baseline cognition, vascular comorbidity, and Apolipoprotein E genotype) case-control study: delirium cases and no-delirium controls were selected from the overall cohort (N = 566; 24% delirium). Analyses were independently conducted in discovery, replication, and pooled cohorts (39, 36, 75 matched pairs, respectively). Nonparametric signed-rank tests evaluating differences in cytokine levels between matched pairs were used to identify delirium-associated cytokines.

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Section: Discussionmentioning

confidence: 99%

F3‐01‐01: Cytokines and postoperative delirium in older patients undergoing major elective surgery

Vasunilashorn

Marcantonio

2015

Alzheimer's & Dementia

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“…The impact of delirium extends beyond in-hospital illness (12), with evidence of prolonged neurocognitive impairment persisting after hospital discharge (13)(14)(15), higher rates of disposition to long-term care facilities (16) and poor functional status, and decreased quality of life (17,18). These effects are more profound and last longer in the elderly after discharge from the ICU (19).…”

mentioning

confidence: 99%

Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients*

Shehabi

Riker

Bokesch

et al. 2010

Critical Care Medicine

402

240

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“…Also, an interaction between the length of persistence of delirium symptoms and functional recovery has been documented: The shorter the persistence of delirium symptoms, the better the functional recovery has been. In particular, persistence of delirium for less than two weeks has been associated with excellent functional recovery 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Further, an association between the length of persistence of delirium symptoms and functional recovery has been documented. The persistence of delirium symptoms for less than two weeks was associated with excellent functional recovery, whereas persistence for a longer time was associated with less favorable outcomes 14 . Even more, delirium predicted greater mortality and accelerated cognitive decline in dementia [15][16][17] .…”

Section: Introductionmentioning

confidence: 90%

Delirium and functionality: the impact of delirium on the level of functioning

Boettger¹,

Breitbart

Jenewein³

et al. 2014

Eur. J. Psychiat.

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-Background and Objectives: Studies have shown showed that delirium affects the long-term functional status, however, the acute effect of delirium on functioning has been less documented. The purpose of this analysis was to examine the acute impact of delirium on the level of functioning.Methods: All patients were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). The Memorial Delirium Assessment Scale (MDAS) and Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2-3 days (T2) and 4-7 days (T3). A secondary analysis in respect to sociodemographic and medical variables, aspects of delirium, and level of functioning was performed.Results: Delirium severity at baseline did not affect the level of functioning, however, resolved delirium resulted in substantial functional recovery compared to persistent delirium at T2 (30.2 and 23.5) and T3 (35.1 and 26.2). Patients with persistent functional impairment were not different in age, pre-existing dementia or brain metastasis compared to those with functional recovery. However, brain cancer, terminal illness, hypoxia and multiple etiologies caused persistent functional decline. Although delirium severity was not different at baseline, delirium was more severe in the functionally-impaired at T2 and T3. Similarly, delirium resolution was inferior in these patients in contrast to the functionally-recovered at T2 (25% and 65.4%) and T3 (62.5% and 83.3%). On the contrary, the duration of delirium affected functional recovery; shorter delirium predicted faster functional recovery.Conclusions: Delirium caused an acute functional decline and appropriate management of delirium with antipsychotics reversed this decline. On the contrary, shorter duration of delirium was associated with faster functional recovery. Brain cancer, terminal illness, hypoxia, and multiple etiologies were confounders for persistent delirium and functional impairment.

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Association Between Delirium Resolution and Functional Recovery Among Newly Admitted Postacute Facility Patients

Cited by 94 publications

References 22 publications

F3‐01‐01: Cytokines and postoperative delirium in older patients undergoing major elective surgery

F3‐01‐01: Cytokines and postoperative delirium in older patients undergoing major elective surgery

Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients*

Delirium and functionality: the impact of delirium on the level of functioning

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