Acute delirium and functional decline in the hospitalized elderly patient.
BACKGROUND
Delirium is often considered a transient cognitive syndrome. Its effect on long-term physical function, however, has not been well defined.


METHODS
In a prospective study of 325 hospitalized community and nursing home elderly, we analyzed the effect of in-hospital delirium on subsequent physical function. ADL performance was assessed prior to admission, and at 3 and 6 months after hospital discharge.


RESULTS
There was a strong univariate (unadjusted) association between incident delirium and functional decline (p < .02). Delirious subjects lost a mean of almost one ADL, as measured 3 months after hospital discharge. Using multivariate linear regression analysis, with adjusted change in function as the dependent variable, delirium persisted as the sole predictor of loss of function (p = .009) at 3 months after discharge. The functional decline persisted at 6 months after hospital discharge.


CONCLUSIONS
This finding of a nontransient, perhaps permanent consequence of delirium invites reexamination of the definition of delirium from that of an acute, reversible syndrome to one of acute onset with long-term sequelae.
Murray
A M
AM
North Central Health Care Facilities, Wausau, WI.
Levkoff
S E
SE
Wetle
T T
TT
Beckett
L
L
Cleary
P D
PD
Schor
J D
JD
Lipsitz
L A
LA
Rowe
J W
JW
Evans
D A
DA
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D001900:Boston; D003693:Delirium / Q000503:physiopathology*; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D016014:Linear Models; D008297:Male; D009735:Nursing Homes; D011446:Prospective Studies; D012307:Risk Factors