Association between delirium resolution and functional recovery among newly admitted postacute facility patients.
BACKGROUND
Delirium is common among hospitalized elders and may persist for months. The adverse impact of delirium on independence may increasingly occur in the postacute care (PAC) setting. The purpose of this study is to examine the association between delirium resolution and functional recovery in skilled nursing facilities specializing in PAC.


METHODS
Patients were screened for delirium on admission after an acute hospitalization at PAC facilities. Only patients with "Confusion Assessment Method"-defined delirium were enrolled. Delirium and activities of daily living were assessed prehospital, at PAC admission, and at four (2-week, and 1-, 3-, and 6-month) follow-up assessments to measure functional ability. Four distinct delirium resolution groups were created ranging from resolution within 2 weeks without recurrence to no resolution over 6 months. Repeated-measures analysis of covariance was used to determine if functional performance differed over time by delirium resolution status.


RESULTS
Among the 393 PAC patients, functional recovery differed significantly (p <.0001) by delirium resolution status. Patients who resolved their delirium by 2 weeks without recurrence regained 100% of their prehospital functional level, whereas patients who never resolved their delirium retained less than 50% of their prehospital functional level. Patients with slower resolving delirium and recurrent delirium had intermediate functional outcomes.


CONCLUSIONS
Resolution of delirium among PAC patients appears to be a prerequisite for functional recovery. Delirium resolution within 2 weeks without recurrence is associated with excellent functional recovery. Effective strategies to resolve delirium promptly and prevent its recurrence in the PAC setting will likely benefit patient rehabilitation and functional recovery.
Kiely
Dan K
DK
Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA. kiely@mail.hrca.harvard.edu
Jones
Richard N
RN
Bergmann
Margaret A
MA
Murphy
Katharine M
KM
Orav
E John
EJ
Marcantonio
Edward R
ER
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D003693:Delirium / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D012008:Recurrence; D012866:Skilled Nursing Facilities; D013997:Time Factors