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- Title
Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study.
- Authors
Inouye, Sharon K.; Rushing, Julia T.; Foreman, Marquis D.; Palmer, Robert M.; Pompei, Peter; Inouye; Inouye, S K; Rushing, J T; Foreman, M D; Palmer, R M; Pompei, P
- Abstract
<bold>Objective: </bold>To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline.<bold>Design: </bold>Three prospective cohort studies.<bold>Setting: </bold>Three university-affiliated teaching hospitals.<bold>Patients: </bold>Consecutive samples of 727 patients, aged 65 years and older.<bold>Measurements and Main Results: </bold>Delirium was present at admission in 88 (12%) of 727 patients. The main outcome measures at hospital discharge and 3-month follow-up were death, new nursing home placement, death or new nursing home placement, and functional decline. At hospital discharge, new nursing home placement occurred in 60 (9%) of 692 patients, and the adjusted odds ratio (OR) for delirium, controlling for baseline covariates of age, gender, dementia, APACHE II score, and functional measures, was 3.0, (95% confidence interval [CI] 1.4, 6.2). Death or new nursing home placement occurred in 95 (13%) of 727 patients (adjusted OR for delirium 2.1, 95% CI 1.1, 4.0). The findings were replicated across all sites. The associations between delirium and death alone (in 35 [5%] of 727 patients) and between delirium and length of stay were not statistically significant. At 3-month follow-up, new nursing home placement occurred in 77 (13%) of 600 patients (adjusted OR for delirium 3.0; 95% CI 1.5, 6.0). Death or new nursing home placement occurred in 165 (25%) of 663 patients (adjusted OR for delirium 2.6; 95% CI 1.4, 4.5). The findings were replicated across all sites. For death alone (in 98 [14%] of 680 patients), the adjusted OR for delirium was 1.6 (95% CI 0.8, 3.2). Delirium was a significant predictor of functional decline at both hospital discharge (adjusted OR 3.0; 95% CI 1.6, 5.8) and follow-up (adjusted OR 2.7; 95% CI 1.4, 5.2).<bold>Conclusions: </bold>Delirium is an important independent prognostic determinant of hospital outcomes including new nursing home placement, death or new nursing home placement, and functional decline-even after controlling for age, gender, dementia, illness severity, and functional status. Thus, delirium should be considered as a prognostic variable in case-mix adjustment systems and in studies examining hospital outcomes in older persons.
- Subjects
UNITED States; DELIRIUM in old age; HOSPITAL patients; PSYCHIATRIC drugs; MORTALITY; APACHE (Disease classification system); COMPARATIVE studies; DELIRIUM; HOSPITAL care; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PROGNOSIS; RESEARCH; RESEARCH funding; ACTIVITIES of daily living; EVALUATION research; HOSPITAL mortality
- Publication
JGIM: Journal of General Internal Medicine, 1998, Vol 13, Issue 4, p234
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1046/j.1525-1497.1998.00073.x