Delirium in Frail Older Adults

Kwak, Min Ji

doi:10.4235/agmr.21.0082

Cited by 12 publications

(9 citation statements)

References 86 publications

(147 reference statements)

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“…Delirium and frailty, especially in advanced stages marked by functional disability, exhibit a mutually independent relationship, as demonstrated by the results of a meta‐analysis by Perisco et al, which reported that patients afflicted with frailty faced a 2.2‐fold heightened risk of developing delirium 32 . These conditions are multifactorial in etiology, sharing common underlying factors, such as age‐related inflammation, vascular alterations, nutritional deficiencies, and multimorbidity 33 . Delirium prevention assumes paramount importance, as pharmacological interventions are often associated with significant adverse effects, 34 whereas nonpharmacological interventions are frequently rendered ineffective once the complication has manifested 35 …”

Section: Discussionmentioning

confidence: 99%

Geriatric care‐related outcomes in patients 75 years and older admitted to a pulmonary disease center and predictors for hospital‐related complications

Cataneo‐Piña,

Hernández‐Favela,

Mondragón‐Posadas

et al. 2023

Aging Medicine

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ObjectiveThe primary aim of this study was to evaluate the influence of targeted interventions, administered through comprehensive geriatric assessments on the incidence of hospitalization‐related complications among older adults diagnosed with pulmonary diseases.MethodsA retrospective analysis of medical records encompassed individuals aged 75 years and older who were admitted to a lung center during the period spanning from March to June 2023. These admissions occurred in a context where standardized geriatric management protocols were systematically implemented. This study's scope extended to assessing the prevalence of hospital‐related complications, encompassing delirium and pressure ulcers. A rigorous multivariate logistic regression analysis was conducted to discern and characterize associated factors.ResultsThe integration of comprehensive geriatric assessment yielded a substantial reduction in in‐hospital complications among the cohort of 118 patients (mean age : 82.1 ± 5.6 years, 44.5% women). The incidence of delirium decreased from 53.3% to 21.8% [odds ratio (OR): 0.246, 95% confidence interval (CI): 0.134–0.450, p < 0.001], whereas the presence of pressure ulcers decreased from 43.9% to 25% (OR: 0.395, 95% CI: 0.217–0.715, p < 0.001). The multivariate analysis uncovered independent associations between delirium and variables including community‐acquired pneumonia (OR: 4.417, 95% CI : 1.574–12.395, p = 0.005), severe disability (OR: 2.981, 95% CI: 1.140–7.798, p = 0.026), and hearing loss (OR: 3.219, 95% CI : 1.260–8.170, p = 0.014). Prolonged hospital stays emerged as the sole factor significantly associated with pressure ulcers (OR: 1.071, 95% CI: 1.033–1.109). Furthermore, an intricate bidirectional relationship was evident between delirium and pressure ulcers (OR: 7.158, 95% CI: 2.962–17.300, p < 0.01).ConclusionIn conjunction with its consequent interventions, geriatric evaluation assumes a pivotal role in ameliorating adverse outcomes stemming from hospitalization among older adults afflicted with pulmonary ailments. This role gains particular salience among subpopulations characterized by heightened susceptibility, such as individuals coping with hearing loss and severe disability.

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Section: Discussionmentioning

confidence: 99%

Geriatric care‐related outcomes in patients 75 years and older admitted to a pulmonary disease center and predictors for hospital‐related complications

Cataneo‐Piña,

Hernández‐Favela,

Mondragón‐Posadas

et al. 2023

Aging Medicine

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Sahle

Pilcher

Litton

et al. 2022

Ann. Intensive Care

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Background Frailty and delirium are prevalent among older adults admitted to the intensive care unit (ICU) and associated with adverse outcomes; however, their relationships have not been extensively explored. This study examined the association between frailty and mortality and length of hospital stay (LOS) in ICU patients, and whether the associations are mediated or modified by an episode of delirium. Methods Retrospective analysis of data from the Australian New Zealand Intensive Care Society Adult Patient Database. A total of 149,320 patients aged 65 years or older admitted to 203 participating ICUs between 1 January 2017 and 31 December 2020 who had data for frailty and delirium were included in the analysis. Results A total of 41,719 (27.9%) older ICU patients were frail on admission, and 9,179 patients (6.1%) developed delirium during ICU admission. Frail patients had significantly higher odds of in-hospital mortality (OR: 2.15, 95% CI 2.05–2.25), episodes of delirium (OR: 1.86, 95% CI 1.77–1.95), and longer LOS (log-transformed mean difference (MD): 0.24, 95% CI 0.23–0.25). Acute delirium was associated with 32% increased odds of in-hospital mortality (OR: 1.32, 95% CI 1.23–1.43) and longer LOS (MD: 0.54, 95% CI 0.50–0.54). The odds ratios (95% CI) for in-hospital mortality were 1.37 (1.23–1.52), 2.14 (2.04–2.24) and 2.77 (2.51–3.05) for non-frail who developed delirium, frail without delirium, and frail and developed delirium during ICU admission, respectively. There was very small but statistically significant effect of frailty on in-hospital mortality (b for indirect effect: 0.00037, P < 0.001) and LOS (b for indirect effect: 0.019, P < 0.001) mediated through delirium. Conclusion Both frailty and delirium independently increase the risk of in-hospital mortality and LOS. Acute delirium is more common in frail patients; however, it does not mediate or modify a clinically meaningful amount of the association between frailty and in-hospital mortality and LOS.

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“…Growing knowledge on the importance of the frailty spectrum might be one of the most remarkable achievements in geriatric medicine in this century in person-centered risk assessment and care provision for older adults (4)(5)(6). Measured by either the phenotype or the index, the spectrum of frailty has shown high prediction ability for adverse health outcomes encompassing healthcare use and incidence of geriatric syndromes, such as fall and delirium, as well as disability and death (7,8). These features of frailty have led to a growing research interest in incorporating frailty as a risk measure in many specialized fields of medicine outside geriatrics (9).…”

Section: Introductionmentioning

confidence: 99%

Operationalization of the Clinical Frailty Scale in Korean Community-Dwelling Older People

et al. 2022

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BackgroundThe Clinical Frailty Scale (CFS) is a simple measure of global fitness validated in various populations in real-world settings. In this study, we aimed to assess the characteristics and validities of the CFS in community-dwelling older people in Korea, with the original classification tree (oCFS) and a culturally modified tree (mCFS).MethodsThe comprehensive geriatric assessment records of 1,064 individuals of the Aging Study of the Pyeongchang Rural Area were used for this study. For mCFS, we considered the dependency of the food preparations and household chores not to be deficits in the male population. The frailty index was used as a reference for construct validity. We used a composite outcome of death and institutionalization for outcome validity.ResultsThe correlation coefficients with frailty index were higher in mCFS (.535) than in oCFS (.468). The mean frailty index was lower in individuals reclassified by mCFS (5 to 4) than people who stayed in mCFS 5. The classification coefficient of mCFS was significantly higher than that of oCFS (p <0.001) in determining people with frailty (frailty index.25 or higher). Trends of a higher incidence of the composite outcome were observed in both higher oCFS and mCFS, in which oCFS and mCFS did not differ significantly in predicting the risk of the outcome.ConclusionThe classification tree of CFS could be culturally adopted in a community-dwelling population of Korea and considered valid in detecting the vulnerable population.

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Delirium in Frail Older Adults

Cited by 12 publications

References 86 publications

Geriatric care‐related outcomes in patients 75 years and older admitted to a pulmonary disease center and predictors for hospital‐related complications

Geriatric care‐related outcomes in patients 75 years and older admitted to a pulmonary disease center and predictors for hospital‐related complications

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

Operationalization of the Clinical Frailty Scale in Korean Community-Dwelling Older People

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