Geriatric ward hospitalization reduced incidence delirium among older medical inpatients.
OBJECTIVE
Most strategies for delirium prevention in older hospitalized patients are common good clinical geriatric care. We investigated whether acute geriatric ward (AGW) hospitalization, compared with acute general medical ward (AGMW) hospitalization,is associated with reduced incident delirium in older medical inpatients.


METHODS
prospective observational study.


METHODS
a tertiary care, university hospital in Torino.


METHODS
consecutive medical patients 70 years or older admitted from the emergency department to an AGW and to an AGMW were included.


METHODS
Baseline measures included demography, functional and psychocognitive status, comorbidity, physiological and clinical severity of acute illness. Incident delirium was evaluated by qualified psychiatrists according to the Confusion Assessment Method and the Delirium Rating Scale.


RESULTS
Delirium occurred in 8 of 121 patients admitted to AGW (6.6%) and in 20 of 131 patients admitted to AGMW (15.2%). After adjustment for significant differences in baseline covariates between groups, AGW hospitalization remained independently associated with less incident delirium (relative risk 0.90, 95% confidence interval: 0.024-0.331, p <0.001). In a multivariable logistic model with delirium incidence as independent variable, AGW hospitalization was independently associated with lower delirium incidence (relative risk 0.039, 95% confidence interval: 0.007-0.214, p <0.001), whereas greater cognitive impairment (p <0.001), higher Acute Physiology and Chronic Health Evaluation II score (p 0.001) and recent stressful events (p <0.001) were associated with increased delirium incidence.


CONCLUSIONS
AGW hospitalization is associated with less incident delirium among older medical inpatients. Despite inherent limitations of observational studies, these hypothesis-generating findings add to previous evidence of potential benefit in delirium prevention from geriatric consultation in several hospital settings.
Bo
Mario
M
SCDU Geriatria, Dipartimento Discipline Medico Chirurgiche, Azienda Ospedaliera Universitaria San Giovanni Battista-Molinette-C.so Bramante 88, 10126, Torino, Italia.
Martini
Barbara
B
Ruatta
Claudia
C
Massaia
Massimiliano
M
Ricauda
Nicoletta Aimonino
NA
Varetto
Antonella
A
Astengo
Marco
M
Torta
Riccardo
R
D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics; D006757:Hospital Units; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires