Depressive symptoms and the risk of incident delirium in older hospitalized adults.
OBJECTIVE
To determine whether specific subsets of symptoms from the Geriatric Depression Scale (GDS), assessed at hospital admission, were associated with the incidence of delirium.


METHODS
Secondary analysis of a prospective cohort study of patients from the Delirium Prevention Trial.


METHODS
General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998.


METHODS
Four hundred sixteen patients aged 70 and older who were at intermediate or high risk for delirium and were not taking antidepressants at hospital admission.


METHODS
Depressive symptoms were assessed GDS, and daily assessments of delirium were obtained using the Confusion Assessment Method.


RESULTS
Of the 416 patients in the analysis sample, 36 (8.6%) developed delirium within the first 5 days of hospitalization. Patients who developed delirium reported 5.7 depressive symptoms on average, whereas patients without delirium reported an average of 4.2 symptoms. Using a Cox proportional hazards model, it was found that depressive symptoms assessing dysphoric mood and hopelessness were predictive of incident delirium, controlling for measures of physical and mental health. In contrast, symptoms of withdrawal, apathy, and vigor were not significantly associated with delirium.


CONCLUSIONS
These findings suggest that assessing symptoms of dysphoric mood and hopelessness could help identify patients at risk for incident delirium. Future studies should evaluate whether nonpharmacological treatment for these symptoms reduces the risk of delirium.
McAvay
Gail J
GJ
Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, 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; D003071:Cognition; D003693:Delirium / Q000175:diagnosis / Q000209:etiology*; D003863:Depression / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors