Prognosis after hospital discharge of older medical patients with delirium.
OBJECTIVE
To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium.


METHODS
Descriptive cohort study.


METHODS
General medical wards of a teaching hospital.


METHODS
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 greater than or equal to 2 years.


METHODS
Vital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or care-givers 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.
Francis
J
J
Section of Geriatrics and Extended Care, Department of Veterans Affairs Medical Center, Memphis, Tennessee.
Kapoor
W N
WN
D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D015331:Cohort Studies; D003693:Delirium; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009026:Mortality; D010351:Patient Discharge; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors