Outcomes of older people admitted to postacute facilities with delirium.
OBJECTIVE
To compare outcomes of patients admitted to postacute skilled nursing facilities with delirium, subsyndromal delirium, and no delirium.


METHODS
Observational cohort study.


METHODS
Seven skilled nursing facilities that specialize in postacute care within a single metropolitan region.


METHODS
Five hundred four subjects chosen from 1,248 consenting subjects aged 65 and older who underwent mental status testing within 5 days of admission to the participating facilities. Subjects who met full Confusion Assessment Method (CAM) criteria were classified as delirious, those with one or more CAM criteria were classified as having subsyndromal delirium, and those with no CAM features were classified as having no delirium. All subjects with delirium and with available medical records were included. A random subset of subjects with no delirium and subsyndromal delirium with available medical records was included.


METHODS
The medical records of all subjects underwent a structured review by trained research nurses who were masked to the subjects' initial delirium status. Records were reviewed for the development of new complications within the postacute setting and to determine whether the subjects were discharged within 30 days and, if so, the discharge destination. The National Death Index was used to assess 6-month mortality.


RESULTS
Subjects with delirium were more likely to experience one or more complications than subjects with no delirium (73% vs 41%, P < .01). Within 30 days of postacute admission, subjects with delirium were more than twice as likely to be rehospitalized (30% vs 13%), and less than half as likely to be discharged to the community (30% vs 73%) than subjects without delirium (differences P < .01). Subjects with subsyndromal delirium had outcomes intermediate between those with and without delirium. Finally, subjects admitted to the postacute setting with delirium experienced a 6-month mortality rate of 25.0%, compared with 5.7% in subjects admitted without delirium. Subjects with subsyndromal delirium had a 6-month mortality rate of 18.3%.


CONCLUSIONS
Patients admitted to postacute skilled nursing facilities with delirium are more likely to experience complications, rehospitalization, and death than patients without delirium. These findings support the need for improved case finding and management of delirium in postacute care.
Marcantonio
Edward R
ER
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. emarcant@bidmc.harvard.edu
Kiely
Dan K
DK
Simon
Samuel E
SE
John Orav
E
E
Jones
Richard N
RN
Murphy
Katharine M
KM
Bergmann
Margaret A
MA
D000058:Accidental Falls / Q000706:statistics & numerical data; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003681:Dehydration / Q000453:epidemiology; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000453:epidemiology; D016016:Proportional Hazards Models; D012871:Skin Diseases / Q000453:epidemiology; D016019:Survival Analysis; D014552:Urinary Tract Infections / Q000453:epidemiology