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Outcomes in delirium: same but different

Published online by Cambridge University Press:  24 July 2014

Robert Renjel  and
Eamonn Eeles
Robert Renjel*
Affiliation:
The University of Queensland, Ochsner Clinical School, Jefferson, USA
Eamonn Eeles
Affiliation:
University of Queensland and the Prince Charles Hospital, Brisbane, Australia
*
Address for correspondence: Robert Renjel, The University of Queensland, Ochsner Clinical School, 1514 Jefferson Highway, Jefferson, LA 70121, USA. Email: [email protected]
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Summary

Delirium has been associated with institutionalization, increased length of hospital stay, cognitive and functional decline and mortality. Research in the last thirty years has recognized that accurate diagnostic criteria allow for targeted interventions for those suffering from delirium. However, despite the advances made in understanding delirium, adverse outcomes persist.

This article will first review how the evolution of diagnostic criteria has fostered improvements in the recognition of delirium and facilitated the development of therapeutic strategies. Second, we discuss how this foundation in approach to delirium has influenced outcomes and the evidence for causality. Finally, the candidate factors responsible for propagating adverse events are considered and future research direction outlined.

Keywords

deliriuminstitutionalizationmortalityinpatientsoutcome assessment
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 3 , August 2014 , pp. 182 - 190
Copyright
Copyright © Cambridge University Press 2014 

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References

1American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn.Washington, DC: American Psychiatric Association, 2013.Google Scholar
2Inouye, SK, Rushing, JT, Foreman, MDet al.Does delirium contribute to poor hospital outcomes? J Gen Intern Med 1998; 13: 234–42.CrossRefGoogle ScholarPubMed
3Siddiqi, N, House, A, Holmes, J. Occurrence and outcome of delirium in medical in-patients: a systemic literature review. Age Ageing 2006; 35: 350–64.CrossRefGoogle Scholar
4Bellelli, G, Morandi, A, Davis, Det al. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalized older people. Age Ageing 2014; Epub ahead of print.CrossRefGoogle Scholar
5Inouye, SK, Schlesinger, M, Lydon, T. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999; 106: 565–73.CrossRefGoogle Scholar
6Cole, M, Ciampi, A, Belize, E, Zhong, L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing 2009; 38: 19–26.CrossRefGoogle ScholarPubMed
7Martins, S, Fernandes, L. Delirium in elderly people: a review. Front Neurol 2012; 3: 101–12.CrossRefGoogle ScholarPubMed
8Shakespeare, W.The Life and Death of King John; act V; scene 7; lines 13–20.Google Scholar
9Sarma, Visnu. The Panachatantra, translated from the Sanskrit by Chandra Rajan, London: Penguin Books, 1993.Google Scholar
10American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd edn.Washington, DC: American Psychiatric Association, 1980.Google Scholar
11Rabins, PV, Fistein, MF. Delirium and dementia: diagnostic criteria and fatality rates. Br J Psychiatry 1982; 140: 149–53.CrossRefGoogle ScholarPubMed
12Fields, SD, Mackenzie, CR, Charlson, MEet al.Reversibility of cognitive impairment in medical inpatients. Arch Intern Med 1986; 146: 1593–96.CrossRefGoogle ScholarPubMed
13Levkoff, SE, Evans, DA, Liptzin, Bet al.The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992; 152: 334–40.CrossRefGoogle ScholarPubMed
14Thomas, RI, Cameron, DJ, Fahs, MC. A prospective study of delirium and prolonged hospital stay: exploratory study. Arch Gen Psychiatry 1988; 45: 937–40.CrossRefGoogle ScholarPubMed
15Levkoff, SE, Safran, C, Cleary, PDet al.Identification of factors associated with the diagnosis of delirium in elderly hospitalized patients. J Am Geriatr Soc 1988; 36: 1099–104.CrossRefGoogle ScholarPubMed
16Rockwood, K.Delays in the discharge of elderly patients. J Clin Epidemiol 1990; 43: 971–75.CrossRefGoogle ScholarPubMed
17Koponen, H, Stenback, U, Mattila, E, Soininen, H, Reinikainen, K, Riekkinen, PJ. Delirium among elderly persons admitted to a psychiatric hospital: clinical course during the acute stage and one year follow-up. Acta Psychiatr Scand 1989; 79: 579–85.CrossRefGoogle ScholarPubMed
18Rockwood, K.Acute confusion in elderly medical patients. J Am Geriatr Soc 1989; 37: 150–54.CrossRefGoogle ScholarPubMed
19Francis, J, Martin, D, Kapoor, WN. A prospective study of delirium in hospitalized elderly. JAMA 1990; 263: 1097–101.CrossRefGoogle ScholarPubMed
20Ramsay, R, Wright, P, Katz, A, Bielawska, C, Katona, C. The detection of psychiatric morbidity and its effects on outcome in acute elderly medical admissions. Int J Geriatr Psychiatry 1991; 6: 861–66.CrossRefGoogle Scholar
21Murray, AM, Levkoff, SE, Wetle, TTet al.Acute delirium and functional decline in the hospitalized elderly patients. J Gerontol A Biol Sci Med Sci 1993; 48: M181–86.CrossRefGoogle Scholar
22Rockwood, K.The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol 1993; 48: M162–66.CrossRefGoogle ScholarPubMed
23Francis, J, Kappor, WN. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc 1992; 40: 601–6.CrossRefGoogle ScholarPubMed
24Jitapunkul, S, Pillay, I, Ebrahim, S. Delirium in newly admitted elderly patients: a prospective study. Q J Med 1992; 83: 307–14.Google ScholarPubMed
25Pompei, P, Foreman, M, Rudberg, MA, Inouye, SK, Braund, V, Cassel, CK. Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc 1994; 42: 809–15.CrossRefGoogle ScholarPubMed
26Cole, MG, Primeau, FJ, Bailey, RFet al.Systematic intervention for elderly inpatients with delirium: a randomized trial. CMAJ 1994; 151: 965–70.Google ScholarPubMed
27O’Keefe, S, Lavan, J. The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 1997; 45: 174–78.CrossRefGoogle Scholar
28O’Keeffe, S, Lavan, J. Clinical significance of delirium subtypes in older people. Age Ageing 1999; 28: 115–19.CrossRefGoogle ScholarPubMed
29McCusker, J, Cole, M, Dendukuri, N, Belzile, E, Primeau, F. Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ 2001; 165: 575–83.Google ScholarPubMed
30McCusker, J, Cole, M, Abrahamowicz, Met al.Delirium predicts 12-month mortality. Arch Intern Med 2002; 162: 457–63.CrossRefGoogle ScholarPubMed
31McCusker, J, Cole, MG, Dendukuri, N, Belzile, E. Does delirium increase hospital stay? J Am Geriatr Soc 2003; 51: 1539–46.CrossRefGoogle ScholarPubMed
32Villalpando-Berumen, JM, Pineda-Colorado, AM, Palacios, P, Reyes-Guerrero, J, Villa, AR, Gutierrez-Robledo, LM. Incidence of delirium, risk factors, and long-term survival of elderly patients hospitalized in a medical specialty teaching hospital in Mexico City. Int Psychogeriatr 2003; 15: 325–336.CrossRefGoogle Scholar
33Leslie, DL, Zhang, Y, Holford, TRet al.Premature death associated with delirium at 1-year follow-up. Arch Intern Med 2005; 165: 1657–62.CrossRefGoogle ScholarPubMed
34Sylvestre, MP, McCusker, J, Cole, M, Regeasse, A, Belzile, E, Abrahamowicz, M. Classification and patterns of delirium severity scores over time in an elderly population. Int Psychogeriatr 2006; 18: 667–80.CrossRefGoogle Scholar
35Murray, A, Levkoff, S, Wetle, Tet al.Acute delirium and functional decline in the hospitalized elderly patient. J Gerontol 1993; 48: M181–86.CrossRefGoogle ScholarPubMed
36Andrews, M, Freter, S, Rockwood, K. Incomplete functional recovery after delirium in elderly people: a prospective cohort study. BMC Geriatrics 2005; 5: 5.CrossRefGoogle Scholar
37Rockwood, K, Cosway, S, Carver, D, Jarrett, P, Stadnyk, K. The risk of dementia and death after delirium. Age Ageing 1999; 28: 551–56.CrossRefGoogle ScholarPubMed
38McAvay, GJ, Van Ness, PH, Bogardus, STet al.Older adults discharged from the hospital with delirium: 1-year outcomes. J Am Geriatr Soc 2006; 54: 1245–50.CrossRefGoogle ScholarPubMed
39American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn.Washington, DC: American Psychiatric Association, 2000.Google Scholar
40Lundstrom, M, Edlund, A, Karlsson, S, Brannstrom, B, Bucht, G, Gustafson, Y. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 2005; 53: 622–28.CrossRefGoogle ScholarPubMed
41Eeles, E, Hubbard, R, White, S, O’Mahony, MS, Savva, G, Bayer, A. Hospital use, institutionalization and mortality associated with delirium. Age Ageing 2010; 39: 470–75.CrossRefGoogle ScholarPubMed
42Adamis, D, Treloar, A, Martin, FCet al.Recovery and outcome of delirium in elderly medical inpatients. Arch Gerontol Geriatrics 2006; 43: 289–98.CrossRefGoogle ScholarPubMed
43Rahkonen, T, Makela, H, Paanila, S, Halonen, P, Sivenius, J, Sulkava, R. Delirium in elderly people without severe predisposing disorders: etiology and 1-year prognosis after discharge. Int Psychogeriatr 2000; 12: 473–81.CrossRefGoogle ScholarPubMed
44Mercantonio, E, Bergmann, M, Kiely, D, Orav, J, Jones, R. Randomized trial of a delirium abatement program for post-acute skilled nursing facilities. J Am Geriatr Soc 2010; 58: 1019–26.Google Scholar
45British Geriatrics Society and Royal College of Physicians of London. The prevention, diagnosis, and management of delirium in older people. Concise Guidance to Good Practice Series, No. 6. London: RCP, 2006.CrossRefGoogle Scholar
46Lee, EA, Gibbs, NE, Fahey, L, Whiffen, TL. Making hospitals safer for older adults: updating quality metrics by understanding hospital-acquired delirium and its link to falls. Perm J 2013; 17: 32–36.CrossRefGoogle ScholarPubMed
47Davis, DH, Muniz Terrera, Get al.Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain 2012; 135: 2809–16.CrossRefGoogle Scholar
48Representative Poetry Online – Alexander Pope: Epistles to Several Persons: Epistle to Dr Arbuthnot: complete poem and commentary. Available at: http://rpo.library.utoronto.ca/poems/epistles-several-persons-epistle-dr-arbuthnot (accessed 25 May 2014.Google Scholar
49Travers, C, Byrne, GJ, Pachana, NA, Klein, K, Gray, L. Delirium in Australian hospitals: a prospective study. Curr Gerontol Geriat Res 2013; doi: 10.1155/2013/284780. Epub 12 September 2013.CrossRefGoogle Scholar
50The Mid Staffordshire NHS Foundation Trust. Chaired by Robert Francis QC. http://www.midstaffspublicinquiry.com/report (accessed 28 May 2014).Google Scholar
51Renjel, R, Pandy, S, Eeles, E. Delirium in medical inpatients: adverse outcomes. OA Medical Hypothesis 2013; 30; 1: 4.Google Scholar