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Delirium in elderly patients: association with educational attainment

Published online by Cambridge University Press:  09 August 2016

Sónia Martins Open the ORCID record for Sónia Martins [Opens in a new window] ,
José Artur Paiva ,
Mário R. Simões Open the ORCID record for Mário R. Simões [Opens in a new window]  and
Lia Fernandes Open the ORCID record for Lia Fernandes [Opens in a new window]
Sónia Martins
Affiliation:
Center for Health Technology and Services Research/CINTESIS. Faculty of Medicine, University of Porto, Portugal
José Artur Paiva
Affiliation:
Intensive Care and Emergency Autonomous Management Unit, CHSJ. Faculty of Medicine, University of Porto, Portugal
Mário R. Simões
Affiliation:
PsyAssessmentLab. Cognitive and Behavioural Center for Research and Intervention/CINEICC. Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
Lia Fernandes*
Affiliation:
Center for Health Technology and Services Research/CINTESIS. Faculty of Medicine, University of Porto. Clinic of Psychiatry and Mental Health, CHSJ, Porto, Portugal
*
Lia Fernandes, Faculty of Medicine, University of Porto, Al. Hernâni Monteiro, 4200-319 Porto, Portugal. Tel: +00 351 22 205 2525; Fax: +00 351 22 551 3623; E-mail: [email protected]
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Abstract

Objective

Among cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium.

Methods

The study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service. Exclusion criteria were as follows: Glasgow Coma Scale (total≤11), blindness/deafness, inability to communicate or to speak Portuguese. The European Portuguese Version of the Confusion Assessment Method (CAM) was used for delirium assessment.

Results

The final sample (n=157) had a mean age of 78.8 (SD=7.6) the majority being female (52.2%), married (51.5%) and with low educational level (49%). According to CAM, 21% of the patients had delirium. The delirium group presented the fewest years of education (median 1 vs. 4), with statistical significance (p=0.003). Delirium was more frequent among male patients [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.12–0.86; p=0.023], as well as those patients with lower education (OR 0.76; 95% CI 0.62–0.95; p=0.016), and with respiratory disease (OR 3.35; 95% CI 1.20–9.33; p=0.020), after controlling for age and medication.

Conclusion

Similar to previous studies, these findings point to a negative correlation between education and delirium. This study appears as an attempt to contribute to the knowledge about the role of cognitive reserve in risk of delirium, particularly because is the first one that has been carried out in an IMCU, with lower educated elderly patients. Further studies are needed to clarify this relationship considering other markers (e.g. cognitive activities), which can contribute to the definition of preventive strategies.

Keywords

agedcognitive reservedeliriumeducational status
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 29 , Issue 2 , April 2017 , pp. 95 - 101
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Copyright
© Scandinavian College of Neuropsychopharmacology 2016 

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