Premium
Prognosis after Hospital Discharge of Older Medical Patients with Delirium
Author(s) -
Francis Joseph,
Kapoor Wishwa N.
Publication year - 1992
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1992.tb02111.x
Subject(s) - medicine , delirium , odds ratio , confidence interval , confounding , activities of daily living , population , gerontology , physical therapy , intensive care medicine , environmental health
Objective To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium. Design Descriptive cohort study. Setting General medical wards of a teaching hospital. Patients Two hundred twenty‐nine consecutive patients aged 70 years or older who had been community‐dwelling prior to admission. Fifty patients met criteria for delirium (cases); these were compared to patients without delirium (controls). Two‐hundred twenty‐three patients survived hospitalization (46 cases, 177 controls) Of these, 92% were followed ≥2 years. Main Outcome Measures Vital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or caregivers 2 years after discharge. Independent community living was defined as survivorship outside of an institution and without dependence in any of four basic ADL (bathing, dressing, transfers, eating). Results Two‐year mortality in the entire population was 39% for cases and 23% for controls (relative risk 1.82, 95% confidence interval 1.04–3.19). Delirium identified those patients at risk for loss of independent community living, even after adjustment for potential confounding variables (adjusted odds ratio 2.56, 95% confidence interval 1.10–5.91). Follow‐up cognitive testing in a subset of patients with high baseline performance revealed a greater decline in performance among cases of delirium than controls ( P = 0.023). Conclusions Delirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.