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Delirium among elderly patients admitted to a post‐acute care facility and 3‐months outcome
Author(s) -
Miu Doris Ka Ying,
Chan Ching Wai,
Kok Ching
Publication year - 2016
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/ggi.12521
Subject(s) - delirium , medicine , cognitive impairment , comorbidity , acute care , residence , emergency medicine , pediatrics , physical therapy , cognition , intensive care medicine , psychiatry , health care , demography , sociology , economics , economic growth
Aim To investigate the prevalence and risk factors of delirium in an extended care unit, the persistence of delirium and 3‐month outcome. Method Patients aged >65 years were recruited. Basic demographic data, medical comorbidity using the C harlson C omorbidity I ndex, pre‐existing cognitive impairment using the informant questionnaire on cognitive decline in the elderly, place of residence and physical function as measured by the modified B arthel I ndex were recorded. Delirium was assessed by the C onfusion A ssessment M ethod and D irect O bservation S cale. Delirium status, physical function and placement were reassessed on discharge, and at 1 month and 3 months after discharge. Results A total of 261 patients were recruited with a mean age of 81.9 years. Delirium was present in 89 participants (34.1%). Of these, 70 patients continued to be delirious on discharge. A total of 76 patients had persistent delirium at 1 month, and 49 remained to be delirious at 3 months. Pre‐existing cognitive impairment ( OR 9.12), use of psychoactive drugs ( OR 3.61), presence of metabolic disturbances ( OR 3.53), acute infection ( OR 3.49) and old age home residents ( OR 3.04) were associated with delirium on admission. A smaller number of delirium patients can return home on discharge, and they have poorer functional status on admission, at discharge, and at 1 month and 3 months after discharge. Unplanned hospital admission was significantly higher among the delirium group (42.9% vs 24.1%, P < 0.001). Conclusion Delirium in post‐acute convalescence units is highly prevalent and persistent. It is associated with poor functional recovery, higher nursing home placement and unplanned hospital admission. These findings reinforce the necessity to implement a program to prevent, early detect and treat delirium in elderly patients admitted to post‐acute care units. Geriatr Gerontol Int 2016; 16: 586–592.