Hospital use, institutionalisation and mortality associated with delirium

Eeles, Eamonn; Hubbard, Ruth E.; White, Susan V.; O'Mahony, M Sinead; Savva, George M.; Bayer, Antony James

doi:10.1093/ageing/afq052

Cited by 95 publications

(79 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Delirium is also associated with multiple adverse outcomes including patient falls [5], longer length of stay [6], higher readmission rates [7,8], increased costs of care [9], nursing home placement [10], long-term cognitive impairment [11] and mortality [12].…”

Section: Introductionmentioning

confidence: 99%

Predicting delirium: a review of risk-stratification models

Newman

O’Dwyer

Rosenthal

2015

General Hospital Psychiatry

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Predicting delirium: a review of risk-stratification models

Newman

O’Dwyer

Rosenthal

2015

General Hospital Psychiatry

View full text Add to dashboard Cite

“…Studies reporting associated mortality all showed a detrimental effect of delirium even up to 5 years from the index event but by a varying magnitude. 13,19,25,37,41 The need for long-term care following delirium remains a consistent finding in the delirium literature. 2,21,22,26,28,29,33,36,38 Delirium outcomes are studied in the context of confounders such as severity of illness, disability and dementia and would appear to remain an independent predictor of adverse event.…”

Section: Changing Criteria For Delirium Diagnosismentioning

confidence: 89%

Outcomes in delirium: same but different

Renjel¹,

Eeles

2014

Rev. Clin. Gerontol.

View full text Add to dashboard Cite

Delirium has been associated with institutionalization, increased length of hospital stay, cognitive and functional decline and mortality. Research in the last thirty years has recognized that accurate diagnostic criteria allow for targeted interventions for those suffering from delirium. However, despite the advances made in understanding delirium, adverse outcomes persist. This article will first review how the evolution of diagnostic criteria has fostered improvements in the recognition of delirium and facilitated the development of therapeutic strategies. Second, we discuss how this foundation in approach to delirium has influenced outcomes and the evidence for causality. Finally, the candidate factors responsible for propagating adverse events are considered and future research direction outlined.

show abstract

“…At tissue and organ system level, frailty has effects on the nervous and endocrine system, manifesting as delirium (21) and dementia (22), chronic inflammation (23,24), sarcopaenia (25), anaemia (26) and coagulopathy, steroid hormone dysregulation (27,28), low vitamin D levels, malnutrition (29,30) and insulin resistance (15,31). This can manifest at host organism level as immobility, instability, incontinence and intellectual impairment, often termed the 'giants of geriatrics' (32).…”

Section: Pathophysiological Mechanisms Of Frailtymentioning

confidence: 99%

Frailty Assessment in Acute Care

2015

The Gerontologist

View full text Add to dashboard Cite

IntroductionFor some people, ageing is associated with the experience of increased co-morbidity, functional impairment, poor resilience and heightened vulnerability to external stressors, resulting in reduced lifespan as well as health-span. This frailty phenomenon poses challenges to health care systems in the form of increased patient complexity and resource utilisation. The acute care setting, characterised by time-pressure and high patient turn-over, is under strain and struggles to recognise and subsequently reliably intervene, to prevent, reverse or halt the decline of this vulnerable cohort. MethodsThis mixed-methods study probes existing evidence and 'real-world' processes with a systematic review of frailty assessments developed or validated in the acute care setting and a survey of contemporaneous clinical practice in London Acute Medical Units. Content validation and understanding of contextual factors for ideal frailty assessment in acute care is explored using Delphi consensus and Focus Group methodology respectively. The resultant model is developed on existing retrospective national Hospital Episode Statistics data, and prospectively tested on observational data in a local Acute Medical Unit setting. ResultsExisting frailty scores are preponderantly biophysical in nature, and have poor predictive power for adverse outcomes in the acute care setting. In clinical practice, single-dimension assessment tools predominate. Frailty syndromes and previous high resource utilisation in the form of a simple, clinically relevant tool useful to the multidisciplinary team gain consensus as optimal assessment for the setting. Retrospective testing of the frailty model displays moderate predictive powers for adverse events (inpatient mortality, emergency readmission and institutionalisation) and prospective testing provides concurrent (Frailty Index, Age, Co-Morbidity) and comparative predictive validity (Frailty Index, Co-Morbidity, 2 admission National Early Warning Score) with existing risk stratification models in this setting. ConclusionsA risk prediction model based on frailty syndromes and previous high resource utilisation is a valid, feasible and useful for the acute care setting.

show abstract

Hospital use, institutionalisation and mortality associated with delirium

Cited by 95 publications

References 25 publications

Predicting delirium: a review of risk-stratification models

Predicting delirium: a review of risk-stratification models

Outcomes in delirium: same but different

Frailty Assessment in Acute Care

Contact Info

Product

Resources

About