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Predicting outcome in older hospital patients with delirium: a systematic literature review
Author(s) -
Jackson Thomas A,
Wilson Daisy,
Richardson Sarah,
Lord Janet M
Publication year - 2016
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4344
Subject(s) - delirium , psycinfo , medicine , dementia , medline , psychiatry , systematic review , depression (economics) , intensive care medicine , disease , political science , law , economics , macroeconomics
Objective Delirium is a serious neuropsychiatric syndrome common in older hospitalised adults. It is associated with poor outcomes, however not all people with delirium have poor outcomes and the risk factors for adverse outcomes within this group are not well described. The objective was to report which predictors of outcome had been reported in the literature. Methods We performed a systematic review by an initial electronic database search of MEDLINE, Embase and PsycINFO using four key search criteria. These were: (1) participants with a diagnosis of delirium, (2) clearly defined outcome measures, (3) a clearly defined variable as predictor of outcomes and (4) participants in the general hospital, rehabilitation and care home settings, excluding intensive care. Studies were then selected in a systematic fashion using specific predetermined criteria by three reviewers. Results A total of 559 articles were screened, and 57 full text articles were assessed for eligibility. Twenty seven studies describing 18 different predictors of poor outcome were reported. The studies were rated by the Newcastle–Ottawa Score and were generally at low risk of bias. Four broad themes of predictor were identified; five delirium related predictors, two co‐morbid psychiatric illness related predictors, eight patient related predictors and three biomarker related predictors. The most numerously described and clinically important appear to be the duration of the delirium episode, a hypoactive motor subtype, delirium severity and pre‐existing psychiatric morbidity with dementia or depression. These are all associated with poorer delirium outcomes. Conclusion Important predictors of poor outcomes in patients with delirium have been demonstrated. These could be used in clinical practice to focus direct management and guide discussions regarding prognosis. These results also demonstrate a number of key unknowns, where further research to explore delirium prognosis is recommended and is vital to improve understanding and management of this condition. Copyright © 2015 John Wiley & Sons, Ltd.