title: Prognostic significance of delirium in frail older people.
abstract: Our aim was to investigate the long-term prognosis of delirium in the frailest elderly, and to clarify whether delirium is just a marker of the underlying severe disease. We used logistic regression analysis to determine the independent prognostic significance of delirium. A representative sample of 425 patients (> or = 70 years) in acute geriatric wards and nursing homes were assessed at baseline and followed up for 2 years. DSM-IV was used for classification. The prevalence of delirium at baseline was 24.9% (106/425). The prognosis of delirium was poor: mortality at 1 year was 34.9 vs. 21.6% in nondelirious subjects (p = 0.006), and at 2 years 58.5 vs. 42.6% (p = 0.005). Among home-dwelling people at baseline, 54.4% of the delirious vs. 27.9% of others were permanently institutionalized within 2 years (p < 0.001). In logistic regression analysis, delirium was an independent predictor for mortality at 1 year (OR 1.86, 95% CI 1.1-3.1), at 2 years (OR 1.76, 95% CI 1.1-2.8), and for permanent institutionalization (OR 2.45, 95% CI 1.2-4.9). Delirious patients with prior dementia tended to have a better prognosis than those without.
authors.affiliation: Department of Medicine, Geriatric Clinic, Helsinki University Hospital, Helsinki, Finland. kaisu.pitkala@hus.fi
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkala
authors.forename: Jouko V
authors.initials: JV
authors.lastname: Laurila
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.forename: Reijo S
authors.initials: RS
authors.lastname: Tilvis
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000401:mortality; D015897:Comorbidity; D003693:Delirium / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005387:Finland; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005853:Geriatrics; D006707:Homes for the Aged; D006782:Hospitals, Special; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D016019:Survival Analysis