Impact of delirium on mortality and cognitive and functional performance among elderly people with femoral fractures.
OBJECTIVE
To evaluate the evolution of cognitive and functional performance and mortality among elderly patients who were delirious during hospitalization due to femoral fracture.


METHODS
Prospective cohort.


METHODS
Orthopedics and Traumatology Institute of HC-FMUSP; geriatric orthopedic ward.


METHODS
103 patients, aged 60 years or over, who were hospitalized in the geriatric orthopedics ward with femoral fracture in 2001-2002. Thirty of them (29.1%) presented with delirium during their hospital stay and were compared with another 73 (70.9%) who did not present with delirium. There were six deaths, and 97 patients were discharged from the hospital. We obtained information on 85 of these patients four years after discharge; 42 patients were still alive and 43 had died at the time of the evaluation.


METHODS
Data on vital status was obtained for 85 patients. For the 42 survivors, we acquired information on their basic activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive performance (BDRS) by means of telephone interview with the same caregivers who had provided information at the time of the hospitalization. We compared this data with that obtained during their hospitalizations four years prior. For the 43 patients who died, we obtained information regarding their deaths and used this data in the analysis of mortality.


RESULTS
No relationships were observed between delirium and mortality, delirium and cognitive loss, or delirium and functional loss, after four years from discharge of elderly patients with hip fractures. An initial cognitive deficit was a predictor for mortality (RR = 2.54; p = 0.016), functional loss (OR = 1.80; p = 0.027) and cognitive loss (OR = 1.53; p = 0.024). Cognitive loss was also related to age.


CONCLUSIONS
Delirium had no impact on mortality or functional or cognitive losses in long term evolution (2 years) among elderly patients with femoral fractures. An initial cognitive impairment may identify patients at risk of mortality, functional and cognitive losses over the long term evolution.
Furlaneto
Maria Elizabet
ME
Department of Orthogeriatrics - Institute of Orthopedics and Traumatology, - Hospital das Clínicas, São Paulo University Medical School-São Paulo/SP, Brazil. marieli@uol.com.br
Garcez-Leme
Luíz Eugênio
LE
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology*; D003693:Delirium / Q000209:etiology* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000401:mortality; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged