Hospital use, institutionalisation and mortality associated with delirium

Eeles, Eamonn M. P., Hubbard, Ruth E., White, Susan V., O'Mahony, M. Sinead, Savva, George M. and Bayer, Antony J. (2010) Hospital use, institutionalisation and mortality associated with delirium. Age and Ageing, 39 4: 470-475. doi:10.1093/ageing/afq052

Author Eeles, Eamonn M. P.
Hubbard, Ruth E.
White, Susan V.
O'Mahony, M. Sinead
Savva, George M.
Bayer, Antony J.
Title Hospital use, institutionalisation and mortality associated with delirium
Journal name Age and Ageing   Check publisher's open access policy
ISSN 0002-0729
Publication date 2010
Year available 2010
Sub-type Article (original research)
DOI 10.1093/ageing/afq052
Open Access Status
Volume 39
Issue 4
Start page 470
End page 475
Total pages 6
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2010
Language eng
Subject 1302 Curriculum and Pedagogy
2717 Geriatrics and Gerontology
Abstract Background: delirium is a disorder affecting consciousness, which gives rise to core clinical features and associated symptoms. Older patients are particularly prone, owing to higher rates of pre-existing cognitive impairment, frailty, co-morbidity and polypharmacy. Objectives: the aim of this study was to investigate the hypotheses that delirium affects the most vulnerable older adults and is associated with long-term adverse health outcome. Methods: this prospective cohort study evaluated 278 medical patients aged ≥75 years admitted acutely to a district general hospital in South Wales. Patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Assessments also included illness severity, preadmission cognition, co-morbidity and functional status. Patients were followed for 5 years to determine rates of institutionalisation and mortality. Number of days in hospital in the 4 years prior to and 5 years after index admission were recorded. Results: delirium was detected in 103 patients and excluded in 175. Median time to death was 162 days (interquartile range 21-556) for those with delirium compared with 1,444 days (25% mortality 435 days, 75% mortality>5 years) for those without (P < 0.001). After adjusting for multiple confounders, delirium was associated with an increased risk of death (hazard ratio range 2.0-3.5; P ≤ 0.002). Institutionalisation was higher in the first year following delirium (P = 0.03). While those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity, they did not spend more days in hospital in the 4 years prior to index admission. Conclusions: delirium is associated with high rates of institutionalisation and an increased risk of death up to 5 years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome.
Keyword Delirium
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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