Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-08T07:29:18.405Z Has data issue: false hasContentIssue false
  • English
  • Français

Poor functional recovery after delirium is associated with other geriatric syndromes and additional illnesses

Published online by Cambridge University Press:  18 December 2014

Monidipa Dasgupta  and
Chris Brymer
Monidipa Dasgupta*
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Shulich School of Medicine, University of Western Ontario, University Hospital, 339 Windermere Road, London, On, Canada, N6A 5A5 Lawson Health Research Institute, London, Ontario, Canada
Chris Brymer
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Shulich School of Medicine, University of Western Ontario, University Hospital, 339 Windermere Road, London, On, Canada, N6A 5A5
*
Correspondence should be addressed to: Monidipa Dasgupta, Associate Professor, Geriatric medicine-B9-103, University Hospital, 339 Windermere Road, London, ON, CanadaN6A 5A5. Phone: 519-685-8500, ext. 33922#; Fax: 519-663-3472. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Delirious individuals are at increased risk for functional decline, institutionalization and death. Delirium is also associated with other geriatric syndromes, behavioral care issues, and new illnesses. The objectives of this study were to determine how often certain geriatric syndromes, care issues, and additional diagnoses occur in delirious individuals, and to see whether they correlate with worse functional recovery.

Methods:

Consecutive delirious older medical in-patients (n = 343) were followed for the occurrence of geriatric syndromes (falls, pressure ulcers, poor oral intake, and aspiration), care issues (refusing treatments or care, need for sitters, security services, physical restraints, and new neuroleptic medications) and additional diagnoses occurring after the third day of admission. Poor functional recovery was defined by any one of death, permanent institutionalization or increased dependence for activities of daily living (ADLs) at discharge or three months after discharge from hospital, elicited through chart review or a follow-up telephone interview.

Results:

Poor functional recovery was seen in 237 (69%) delirious patients. Geriatric syndromes and additional illnesses were common and associated with poor functional recovery (falls in 21%, adjusted OR 2.27; possible aspiration in 26%, adjusted OR 3.06; poor oral intake in 49%, adjusted OR = 2.31; additional illnesses in 38%, adjusted OR 3.54). Care issues were also common (range 9%–54%) but not associated with poor recovery.

Conclusions:

Geriatric syndromes, behavioral care issues and additional illnesses are common in delirium. Future studies should assess whether monitoring for and intervening against geriatric syndromes and additional illnesses may improve functional outcomes after delirium.

Keywords

deliriumactivities of daily livingaged careadverse events
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 5 , May 2015 , pp. 793 - 802
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, C. P., Ngo, L. H. and Marcantonio, E. R. (2012). Complications in postacute care are associated with persistent delirium. Journal of the American Geriatrics Society, 60, 1122–1127.CrossRefGoogle ScholarPubMed
Breitbart, W., Rosenfeld, B., Roth, A., Smith, M.J., Cohen, K. and Passik, S. (1997). The Memorial Delirium assessment scale. Journal of Pain & Symptom Management, 13, 128–137.CrossRefGoogle ScholarPubMed
Dasgupta, M. and Brymer, C. (2014). Prognosis of delirium in hospitalized elderly: worse than we thought. International Journal of Geriatric Psychiatry, 29, 497–505.Google Scholar
Elie, M., Boss, K., Cole, M.G., McCusker, J., Belzile, E. and Ciampi, A. (2009). A retrospective, exploratory, secondary analysis of the association between antipsychotic use and mortality on elderly patients with delirium. International Psychogeriatrics, 21, 588–592.Google Scholar
Fick, D. and Forman, M. (2000). Consequences of not recognizing delirium superimposed on dementia in hospitalized individuals. Journal of Gerontological Nursing, 26, 30–40.Google Scholar
Fillenbaum, G. (1978). Multidimensional Functional Assessment: The OARS Methodology- A Manual, 2 nd edn, Durham, NC: Center for the study of aging and human development, Duke University.Google Scholar
George, J., Bleasdale, S. and Singleton, S. J. (1997). Causes and prognosis of delirium of elderly patients admitted to a district general hospital. Age Ageing, 26, 423–427.Google Scholar
Inouye, S. K. (2006). Delirium in older persons. The New England Journal of Medicine, 354, 1157–1165.Google Scholar
Inouye, S. K., Studenski, S., Tinetti, M. K. and Kuchel, G. A. (2007). Geriatric syndromes: clinical research and policy implications of a core geriatric concept. Journal of the American Geriatric Society, 55, 780–791.Google Scholar
Inouye, S.K., van Dyck, C.H, Alessi, C. A, Balkin, S., Siegal, A.P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. Annals of Internal Medicine, 113, 941–948.Google Scholar
Jorm, A. F. (2004). The informant questionnaire on cognitive decline in the elderly (IQCODE): a review. International Psychogeriatrics, 16, 275–293.CrossRefGoogle ScholarPubMed
Kiely, D. K., Jones, R. N., Bergmann, M. A., Murphy, K. M., Orav, E. J. and Macantonio, E. R. (2006). Association between delirium resolution and functional recovery among newly admitted post acute facility patients. Journal of Gerontology Medical Science, 61, 204–208.Google Scholar
Kiely, D. K. et al. (2009). Persistent delirium predicts greater mortality. Journal of the American Geriatric Society, 57, 55–61.CrossRefGoogle ScholarPubMed
Lakatos, B. E. et al. (2009). Falls in the general hospital: associations with delirium, advanced age and specific surgical procedures. Psychosomatics, 50, 218–226.CrossRefGoogle ScholarPubMed
Levkoff, S. E. et al. (1992). Delirium: the occurrence and persistence of symptoms among elderly hospitalized patients. Archives of Internal Medicine, 152, 334–340.Google Scholar
Marcantonio, E. R., Ta, T., Duthie, E. and Resnick, N. M. (2002). Delirium severity and psychomotor types: their relationship to outcomes after hip fracture repair. Journal of the American Geriatric Society, 50, 850–857.Google Scholar
Marcantonio, E. R. et al. (2005). Outcomes of older people admitted to postacute facilities with delirium. Journal of the American Geriatric Society, 53, 963–969.Google Scholar
McCusker, J., Cole, M., Dendukuri, N., Han, L. and Belzile, E. (2003). The course of delirium in older medical inpatients. A prospective study. Journal of General Internal Medicine, 18, 696–704.Google Scholar
McCusker, J., Kakuma, R. and Abrahamowicz, M. (2002). Predictors of functional decline in hospitalized elderly patients: a systematic review. Journal of Gerontology Medical Science, 57, M569–M577.Google Scholar
Oliver, D., Fergus, D., Martin, F. C. and McMurdo, M. E. T. (2004). Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing, 33, 122–130.Google Scholar
Parmelee, P. A., Thuras, P. D., Katz, I. R. and Lawton, M. P. (1995). Validation of the cumulative illness rating scale in a geriatric residential population. Journal of the American Geriatric Society, 43, 130–137.Google Scholar
Saravay, S. M. et al. (2004). How do delirium and dementia increase length of stay of elderly hospitalized medical inpatients? Psychosomatics, 45, 235–242.Google Scholar
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing, 35, 350–364.Google Scholar
Speciale, S., Bellelli, G., Lucchi, E. and Trabucchi, M. (2007). Delirium and functional recovery in elderly patients. Journal of Gerontology Medical Science, 62, 107–8.Google Scholar
Witlox, J., Eurelings, L. S. M., de Jonghe, J. F. M., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W.A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization and dementia. A meta-analysis. JAMA, 304, 443–451.Google Scholar
Young, L. J. and George, J. (2003). Do guidelines improve the process and outcomes of care in delirium? Age Ageing, 32, 525–528.Google Scholar