The impact of psychomotor subtypes and duration of delirium on 6‐month mortality in hip‐fractured elderly patients

Bellelli, Giuseppe; Carnevali, Lucio; Corsi, Maurizio; Morandi, Alessandro; Zambon, Antonella; Mazzola, Paolo; Galeazzi, Marianna; Bonfanti, A.; Massariello, Francesca; Szabó, Hajnalka; Oliveri, Giulia; Haas, Justin; d’Oro, Luca Cavalieri; Annoni, Giorgio

doi:10.1002/gps.4914

Cited by 27 publications

(25 citation statements)

References 29 publications

(64 reference statements)

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“…This conflicts with what emerged in the only other study that evaluated psychomotor subtypes of COVID‐19‐related delirium, with hyperactive presentations as predominant 28 . Our findings are important in view of the prognostic implications of hypoactive delirium highlighted in non‐COVID‐19 case cohorts 29,30 …”

Section: Discussioncontrasting

confidence: 98%

“…28 Our findings are important in view of the prognostic implications of hypoactive delirium highlighted in non-COVID-19 case cohorts. 29,30 A further important finding of our study is that delirium was significantly associated with increased in-hospital mortality. The relationship between delirium and mortality in COVID-19 has been assessed in very few studies, with inconclusive results.…”

Section: Discussionsupporting

confidence: 50%

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Delirium in Patients with SARS‐CoV‐2 Infection: A Multicenter Study

Rebora

Rozzini

Bianchetti

et al. 2020

J American Geriatrics Society

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for the CoViD-19 Lombardia Team OBJECTIVES: The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN: Multicenter observational cohort study. SETTINGS: Acute medical units in four Italian hospitals. PARTICIPANTS: A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS: Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS: Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION: Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionsupporting

confidence: 50%

Delirium in Patients with SARS‐CoV‐2 Infection: A Multicenter Study

Rebora

Rozzini

Bianchetti

et al. 2020

J American Geriatrics Society

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“…Mean age was 84.9 ± 7.9 (50-97) years-old and average education was 6.1 ± 2.0 (5-13) years [Verhage education score [19] The 4AT scale could be administered to all patients [4.6 ± 4.0 (0-12)] and a score suggesting delirium (i.e., ≥ 4) was obtained in almost half of them [n = 45 (44.1%)]; all cases were subsequently confirmed by GP clinical impression. The CCI was 4.8 ± 2.3 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and the SPPB score was 3.1 ± 2.9 (0-12), accordingly to the expected decrease in the functional status of this selected population.…”

Section: Resultsmentioning

confidence: 83%

“…According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria [1], delirium is an acute disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (i.e., reduced orientation whether in the environment) that develops in a relatively short time-period (usually hours or days). Delirium is almost always triggered by a medical condition or inappropriate use of drugs and is associated with several negative outcomes and high costs of care [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Delirium in your house: a survey during General Practitioner-programmed home visits

Tremolizzo

Bargossi²,

Storti

et al. 2021

Aging Clin Exp Res

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Objectives To assess the prevalence of delirium (DEL) among older patients living at home and periodically visited by their General Practitioners (GPs). Design Observational study. Setting In Italy, programmed home visits by the GPs are regularly scheduled for their vulnerable and frail patients who are often on poly-drug regimens and suffering from dementia. Participants N = 102 patients among those receiving programmed home visits by n = 6 GP based in the Brianza area (Lombardy). Measurements Patients were screened for delirium with the Italian version of the 4AT, with a score ≥ 4 considered as a positive indicator for DEL. The Charlson Comorbidity Index (CCI), the Short Physical Performance Battery (SPPB), the presence of dementia, and benzodiazepine (BZD) use were recorded. Results DEL+ was detected in almost half of the recruited sample (44.1%), and it was clearly associated with increased comorbidity and decreased motor abilities. Pre-existing dementia was documented in most of DEL+ patients (71.1%), while this was the case for only a minority of DEL- (5.2%, p < 0.00001). Analogously, BZD use was over-represented in the DEL+ group with respect to the DEL− one (73.3% vs. 22.8%, p < 0.00001). Conclusions DEL prevalence as detected by GP during programmed home visits is surprisingly high, and related to motor impairment, comorbidities (among which dementia), and BZD use. DEL prompt recognition should be one of the goals of GP-programmed home visits, since this treatable and preventable condition is associated to an elevated burden of frailty and risk of death.

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“…Mosk et al 7 reported that delirium was correlated with a longer hospital stay, increased associated with complications, institutionalization, and 6-month mortality by observing 566 patients with hip fractures who were over the age of 70. Bellelli et al 14 reported that hypoactivity and mixed POD were associated with increased 6-month mortality risk. They observed 571 patients in which the morbidity of delirium was 38.5%, whereas the mortality rates of non-delirium and delirium groups separately were 8.3% and 24.1%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Impact of Delirium on Short-term Prognosis in Geriatric Patients with Hip Fracture

Feng

et al. 2020

Preprint

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Background: To explore the effect of delirium on postoperative early prognosis of geriatric patients with hip fracture. Methods: According to whether postoperative delirium (POD) appeared in elderly patients with hip fracture, all cases were divided into two groups: delirium and non-delirium. General parameters, operative parameters, length of stay (LOS), and perioperative complications were recorded. Recurrent fracture, new stroke, and mortality within 1 year postoperatively were followed up and compared between the two groups. Results: Of 358 cases, 55 (15.4%) developed delirium. Compared with the non-delirium group, the delirium group had longer operative times (P=0.031); increased platelet (P=0.002) and C-reactive protein (P<0.001) levels; and reduced hemoglobin (P<0.001), calcium (P=0.040), albumin (P<0.001), prealbumin (P<0.001), and total cholesterol (P=0.019) levels. Complications occurred to some extent in 196 cases (54.7%). In the delirium group, complication rates of pulmonary infection (P=0.005), hypoalbuminemia (P<0.001), electrolyte disorder (P<0.001), dyspepsia (P=0.027), bedsore (P=0.012) and anemia (P=0.007) were higher. In addition, LOS was significantly longer (15.71 ± 4.72 vs 14.00 ± 5.30 days; P=0.026) in the delirium group. Within 1 year postoperatively, 31 individuals (8.7%) had died, 13 were treated for recurrent fracture, and 42 had a new stroke. In the delirium group, mortality within 1 year postoperatively was higher (27.3% vs 5.3%, P<0.001). Conclusions: The morbidity of POD is high in geriatric patients with hip fractures. There was longer surgery delay, higher complication rate, longer LOS, and increased mortality in the delirium group. Early intervention of POD has important clinical significance.

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The impact of psychomotor subtypes and duration of delirium on 6‐month mortality in hip‐fractured elderly patients

Abstract: Hyperactive delirium was the most common POD psychomotor subtype, but hypoactive and mixed POD were associated with 6-month mortality risk. Moreover, the risk of death 6 months after surgery increased for both subgroups (hypoactive and mixed) with increasing duration of POD.

Cited by 27 publications

References 29 publications

Delirium in Patients with SARS‐CoV‐2 Infection: A Multicenter Study

Delirium in Patients with SARS‐CoV‐2 Infection: A Multicenter Study

Delirium in your house: a survey during General Practitioner-programmed home visits

Impact of Delirium on Short-term Prognosis in Geriatric Patients with Hip Fracture

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