The diagnosis, prevalence and outcome of delirium in a cohort of older people with mental health problems on general hospital wards

Abstract

Objectives: This paper aimed to measure the prevalence and outcomes of delirium for patients over 70 admitted to a general hospital for acute medical care and to assess the validity of the Delirium Rating Scale-Revised-98 (DRS-R-98) in this setting. Methods: Prospective study in a British acute general hospital providing sole emergency medical services for its locality. We screened consecutive patients over 70 with an unplanned emergency hospital admission and recruited a cohort of 249 patients likely to have mental health problems. They were assessed for health status at baseline and followed over 6 months. A sub-sample of 93 participants was assessed clinically for delirium. Results: 27% (95% confidence interval (CI) 23-31) of all older medical patients admitted to hospital had DRS-diagnosed delirium, and 41% (95% CI 37-45) had dementia (including 19% with co-morbid delirium and dementia). Compared with clinician diagnosis, DRS-R-98 sensitivity was at least 0.75, specificity 0.71. Compared with reversible cognitive impairment, sensitivity was at least 0.50, specificity 0.67. DRS-diagnosed delirium was associated with cognitive impairment, mood, behavioural and psychological symptoms, activities of daily living, and number of drugs prescribed, supporting construct validity. Of those with DRS-diagnosed delirium, 37% died within 6 months (relative risk 1.4, 95% CI 0.97-2.2), 43% had reversible cognitive impairment, but only 25% had clinically important recovery in activities of daily living. Behavioural and psychological symptoms were common and mostly resolved, but new symptoms frequently developed. Conclusion: Delirium is common. Some, but not all, features are reversible. DRS-R-98 has reasonable validity in populations where co-morbid dementia is prevalent.

Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions

“…Higher mortality is reported for delirium [8, 9, 35–37], delirium superimposed on dementia [10, 15, 38], and cognitive impairment irrespective of cause [11]. A striking feature of this study is that outcomes (LOS, mortality after admission, and death or readmission after discharge) are significantly worse in people with any CSD with relatively little difference between different types of CSD, although delirium superimposed on dementia was associated with significantly longer LOS compared to delirium or dementia alone, and dementia alone was associated with significantly higher mortality compared to delirium alone.…”

Delivering dementia care differently—evaluating the differences and similarities between a specialist medical and mental health unit and standard acute care wards: a qualitative study of family carers’ perceptions of quality of care

“…However, hospitals are busy, fast-moving and noisy, making them a difficult place for people with dementia 7. Patients are often ill and dependent2 28 and physical medical care is necessarily prioritised. The necessary medical monitoring and nursing interventions can be misunderstood or seen as threatening.…”

An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives

“…28–30 Although the potential reversibility of delirium has been demonstrated in many settings, 29,31,32 including palliative care, 29,30 though nonreversal is clearly recognized as a frequent outcome in the context of palliative care. 29,33 The reversibility of delirium in this patient population, and the extent to which this can be predicted, is a major research priority.…”