Delirium, how does it end? Mortality as an outcome in older medical inpatients.
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Authors
Muresan, Maria-Laura
Adamis, Dimitrios
Murray, Orla
O'Mahony, Edmond
McCarthy, Geraldine
Issue Date
2015-08-06
Type
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Observational Study
Research Support, Non-U.S. Gov't
Language
en
Keywords
cognition , delirium , length of hospital stay , mortality , outcomes , severity of illness
Alternative Title
Abstract
Delirium is associated with poor outcomes. Previous research in delirium and mortality gave rather inconclusive results. This study aims to find out the rates of mortality at 1 year and the factors associated with it in a cohort of hospitalized older patients.
Prospective, observational, longitudinal study. All acute medical admissions 70 years of age and above were approached within 72 h of admission. Exclusion criteria are as follows: severe aphasia; intubation; severe sensory problems; and non-English speakers. Patients eligible for inclusion were assessed four times, twice weekly during admission. Delirium was defined using the Confusion Assessment Method.
Two hundred patients were recruited. The mean age was 81.13 years (SD = 6.45; minimum 70 and maximum 100 years old), of which 100 (50%) participants were women. One hundred fifty-four (77%) patients never developed delirium during hospitalization. The overall rate of delirium was 23%. A total of 55 (27.5%) patients died during the 1-year follow-up. Although at 1-year follow-up, more people with delirium died (χ(2) = 9.873, df:1, p = 0.002), survival analysis after controlling for other variables showed that mortality was independent of delirium and that severity of illness, longer hospital stay and cognition were significant risk factors for mortality.
Although the sample size precludes drawing any definite conclusion, the findings of this study suggest that delirium is not an important risk factor for subsequent mortality. Perhaps delirium and cognitive impairment share common pathophysiological pathways that are related to mortality and in which the currently used methods cannot detect.
Prospective, observational, longitudinal study. All acute medical admissions 70 years of age and above were approached within 72 h of admission. Exclusion criteria are as follows: severe aphasia; intubation; severe sensory problems; and non-English speakers. Patients eligible for inclusion were assessed four times, twice weekly during admission. Delirium was defined using the Confusion Assessment Method.
Two hundred patients were recruited. The mean age was 81.13 years (SD = 6.45; minimum 70 and maximum 100 years old), of which 100 (50%) participants were women. One hundred fifty-four (77%) patients never developed delirium during hospitalization. The overall rate of delirium was 23%. A total of 55 (27.5%) patients died during the 1-year follow-up. Although at 1-year follow-up, more people with delirium died (χ(2) = 9.873, df:1, p = 0.002), survival analysis after controlling for other variables showed that mortality was independent of delirium and that severity of illness, longer hospital stay and cognition were significant risk factors for mortality.
Although the sample size precludes drawing any definite conclusion, the findings of this study suggest that delirium is not an important risk factor for subsequent mortality. Perhaps delirium and cognitive impairment share common pathophysiological pathways that are related to mortality and in which the currently used methods cannot detect.
Description
Citation
Muresan, M. L., Adamis, D., Murray, O., O'Mahony, E., & McCarthy, G. (2016). Delirium, how does it end? Mortality as an outcome in older medical inpatients. International journal of geriatric psychiatry, 31(4), 349–354. https://doi.org/10.1002/gps.4332
Publisher
License
Copyright © 2015 John Wiley & Sons, Ltd.
Journal
International journal of geriatric psychiatry
Volume
31
Issue
4
PubMed ID
DOI
ISSN
1099-1166