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

Abstract

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.

Social determinants of health and incident postoperative delirium: Exploring key relationships in the SAGES study

“…We found a significant association between the Area Deprivation Index (ADI), a neighborhood disadvantage marker, and delirium severity in the Successful Aging after Elective Surgery (SAGES) cohort 12,13 . Additionally, proxies of childhood socioeconomic status (e.g., parental education, parental occupation) and literacy levels were associated with an increased risk for delirium, and these associations persisted even after controlling for other well‐established risk factors 14–16 . Taken together, our previous work suggests that SDOH factors confer vulnerability for delirium above and beyond other well‐accepted risk factors.…”

“…levels were associated with an increased risk for delirium, and these associations persisted even after controlling for other well-established risk factors. [14][15][16] Taken together, our previous work suggests that SDOH factors confer vulnerability for delirium above and beyond other wellaccepted risk factors. The present study examines variables representing the different domains from our conceptual framework in the SAGES study.…”

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

“…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.…”

“…Moreover, SAGES is well represented with other important social determinants of health, including neighborhood disadvantage and low income levels. [41][42][43][44] 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. Because our focus was to examine the total association of delirium with long-term cognitive decline, we did not control for postdelirium illnesses or events (eg, medications) which may be on the causal pathway between delirium and long-term cognitive decline.…”

The indispensable whole of work and population health: How the working life exposome can advance empirical research, policy, and action

“…WLE-based frameworks can also enable the concurrent use of existing datasets (analogous to European exposome projects based on large-scale data pooled from multiple population, industry, and/or occupational cohorts) and various big data sources, including the exploitation of existing comprehensive and fragmented datasets, as well as the collection of key proxy measures (eg, family health history ( 44 ) to account for pre-working life exposures). Of course, the ongoing quest for comprehensive population-level data remains a significant challenge at the center of work-health-safety research.…”