Delirium Is Not Associated with Mortality in Elderly Hip Fracture Patients

Abstract

Background: The relationship between delirium and mortality remains obscure. The aims of this study were to investigate the effect of delirium and the interaction between delirium and chronic cognitive impairment on mortality in elderly hip fracture patients. Methods: This is a prospective observational study, including 331 hip fracture patients. Information on comorbidity, medications and clinical findings was collected at the time of fracture. Information on cause and time of death was obtained from the Norwegian Cause of Death Register. Patients were screened for delirium by the Confusion Assessment Method. Results: Delirium was not associated with mortality when adjusting for the severity of chronic cognitive impairment, measured by the Infor- mant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Estimated by Kaplan-Meier plots, delirium in patients with dementia was significantly associated with an increased risk of death from stroke (p = 0.004) and dementia (p ≤ 0.001). Conclusions: No association between delirium and mortality was demonstrated when adjusting for the IQCODE score, but delirium in patients with prefracture dementia was associated with an increased risk of death from stroke and dementia. The effect of delirium on the cause of death might be explained by an aggravation of an ongoing neuro-inflammation.

Risk factors of delirium in elderly patients with hip fracture

“…The hip fracture studies that met the inclusion criteria are presented in Table 1. [3], N = 120 52% Age, gender, cognitive*,physical impairment, polymedicine, IL-6,IL-8, length of stay Juliebo et al 2009 [29], N = 364 58% Age, gender*, cognitive*, function*impairment, 21% preop comorbidity, health problem, BMI*, hemoglobin* 36.4% postop sodium, potassium, BUN/Cr ratio, polypharmacy*, Arrhythmia, medication use (psychotropic, selective serotonin reuptake inhibitor, zopiclone, aspirin, betablocker, diuretic, statin) fentanyl* Juliebo et al 2010 [30], N = 331 43.2% Kat et al 2011 [31], N = 603 12.3% postop Bisschop et al 2011 [32], N = 143 34% Age*, gender, preexisting cognitive* and functional* impairment, comorbidity*, laboratory abnormalities*, glucose Lee et al 2011 [33], N = 232 30.2% Age, gender, comorbidity, health problem*, BMI Vochteloo et al 2011 [34], N = 378 27% Age*, gender*,dementia, health problem*, psychotropic drug use*, length of stay* Sieber et al 2011 [35], N = 236…”

Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

“…Furthermore, inadequate treatment of pain may lead to development of delirium [40,41]. Patients with dementia are more prone to develop delirium [6] and worse outcomes [42,43]. On the other hand, careful prescription of particular opioids may be appropriate, as adverse reactions increase with age, frailty, dementia, and higher doses [39,44,45].…”

Systematic review on the inclusion of patients with cognitive impairment in hip fracture trials: a missed opportunity?

“…By some estimates, 30% of patients who sustain a hip fracture also have cognitive impairment or dementia. [3][4][5] There is early evidence to suggest that patients with dementia typically experience poorer functional outcomes and increased morbidity and mortality following a hip fracture. [6][7][8][9][10][11][12][13][14][15] Identifying strategies to optimize outcomes in hip fracture patients with dementia is therefore critically important; however, the extent to which this issue is addressed in orthopedic surgery randomized controlled trials (RCTs) has not been well-elucidated.…”