Older adults discharged from the hospital with delirium: 1-year outcomes.
OBJECTIVE
To compare 1-year institutionalization and mortality rates of patients who were delirious at discharge, patients whose delirium resolved by discharge, and patients who were never delirious in the hospital.


METHODS
Secondary analysis of prospective cohort data from the Delirium Prevention Trial.


METHODS
General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998, with follow-up interviews completed in 2000.


METHODS
Four hundred thirty-three patients aged 70 and older who were not delirious at admission.


METHODS
Patients underwent daily assessments of delirium from admission to discharge using the Confusion Assessment Method. Nursing home placement and mortality were determined at 1-year follow up.


RESULTS
Of the 433 study patients, 24 (5.5%) had delirium at discharge, 31 (7.2%) had delirium that resolved during hospitalization, and 378 (87.3%) were never delirious. After 1 year of follow-up, 20 of 24 (83.3%) patients discharged with delirium, 21 of 31 (67.7%) patients whose delirium resolved, and 157 of 378 (41.5%) patients who were never delirious were admitted to a nursing home or died. Compared with patients who were never delirious, patients with delirium at discharge had a multivariable adjusted hazard ratio (HR) of 2.64 (95% confidence interval (CI)=1.60-4.35) for nursing home placement or mortality, whereas resolved cases had a HR of 1.53 (95% CI=0.96-2.43).


CONCLUSIONS
Delirium at discharge is associated with a high rate of nursing home placement and mortality over a 1-year follow-up period. Interventions to increase detection of delirium and improvements in transitional care may help reduce these negative outcomes.
McAvay
Gail J
GJ
Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut 06510, USA. Gail.McAvay@yale.edu
Van Ness
Peter H
PH
Bogardus
Sidney T
ST
Zhang
Ying
Y
Leslie
Douglas L
DL
Leo-Summers
Linda S
LS
Inouye
Sharon K
SK
D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000401:mortality / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology