Older adults discharged from the hospital with delirium: 1-Year outcomes

Gail J. McAvay, Peter H. Van Ness, Sidney T. Bogardus, Ying Zhang, Douglas Leslie, Linda S. Leo-Summers, Sharon K. Inouye

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Abstract

OBJECTIVES: To compare 1-year institutionalization and mortality rates of patients who were delirious at discharge, patients whose delirium resolved by discharge, and patients who were never delirious in the hospital. DESIGN: Secondary analysis of prospective cohort data from the Delirium Prevention Trial. SETTING: General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998, with follow-up interviews completed in 2000. PARTICIPANTS: Four hundred thirty-three patients aged 70 and older who were not delirious at admission. MEASUREMENTS: Patients underwent daily assessments of delirium from admission to discharge using the Confusion Assessment Method. Nursing home placement and mortality were determined at 1-year follow up. RESULTS: Of the 433 study patients, 24 (5.5%) had delirium at discharge, 31 (7.2%) had delirium that resolved during hospitalization, and 378 (87.3%) were never delirious. After 1 year of follow-up, 20 of 24 (83.3%) patients discharged with delirium, 21 of 31 (67.7%) patients whose delirium resolved, and 157 of 378 (41.5%) patients who were never delirious were admitted to a nursing home or died. Compared with patients who were never delirious, patients with delirium at discharge had a multivariable adjusted hazard ratio (HR) of 2.64 (95% confidence interval (CI)=1.60-4.35) for nursing home placement or mortality, whereas resolved cases had a HR of 1.53 (95% CI=0.96-2.43). CONCLUSION: Delirium at discharge is associated with a high rate of nursing home placement and mortality over a 1-year follow-up period. Interventions to increase detection of delirium and improvements in transitional care may help reduce these negative outcomes.

Original languageEnglish (US)
Pages (from-to)1245-1250
Number of pages6
JournalJournal of the American Geriatrics Society
Volume54
Issue number8
DOIs
StatePublished - Aug 1 2006

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology

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    McAvay, G. J., Van Ness, P. H., Bogardus, S. T., Zhang, Y., Leslie, D., Leo-Summers, L. S., & Inouye, S. K. (2006). Older adults discharged from the hospital with delirium: 1-Year outcomes. Journal of the American Geriatrics Society, 54(8), 1245-1250. https://doi.org/10.1111/j.1532-5415.2006.00815.x