Persistent delirium in older hospital patients.
OBJECTIVE
There are two contradictory views on the prognosis of delirium in older hospital patients. On one hand, the Diagnostic and Statistical Manual, 4th Text Revision (DSM-IV-TR), describes delirium as a transient cognitive disorder, the majority of affected individuals having a full recovery. On the other hand, longitudinal studies of delirium in this population report that the outcomes are poor. This review proposes to reconcile these two contradictory views.


RESULTS
In older hospital patients, delirium appears to persist in 44.7% of patients at discharge and in 32.8, 25.6 and 21% of patients at 1, 3 and 6 months, respectively. The outcomes (cognition, function, nursing home placement, mortality) of patients with persistent delirium are consistently worse than the outcomes of patients who recover from delirium.


CONCLUSIONS
The majority of older hospital patients with delirium may recover but the persistence of delirium in a substantial minority of patients may account, in large part, for the poor outcomes of delirium in this population. This proposal has potentially important implications for clinical practice and research.
Department of Psychiatry, St. Mary's Hospital Center and McGill University, Montreal, Quebec, Canada. martin.cole@ssss.gouv.qc.ca
Martin G
MG
Cole
D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D003693:Delirium / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis