Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease.
BACKGROUND
Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD).


OBJECTIVE
To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with AD.


METHODS
Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer's Disease Research Center (MADRC) patient registry.


METHODS
Community-based.


METHODS
771 persons aged 65 years or older with a clinical diagnosis of AD.


METHODS
Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs).


RESULTS
Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did not have delirium had an increased risk for death (adjusted RR, 4.7 [95% CI, 1.9 to 11.6]) and institutionalization (adjusted RR, 6.9 [CI, 4.0 to 11.7]). With delirium, risk for death (adjusted RR, 5.4 [CI, 2.3 to 12.5]) and institutionalization (adjusted RR, 9.3 [CI, 5.5 to 15.7]) increased further. With hospitalization and delirium, the adjusted RR for cognitive decline for patients with AD was 1.6 (CI, 1.2 to 2.3). Among hospitalized patients with AD, 21% of the incidences of cognitive decline, 15% of institutionalization, and 6% of deaths were associated with delirium.


CONCLUSIONS
Cognitive outcome was missing in 291 patients. Sensitivity analysis was performed to test the effect of missing data, and a composite outcome was used to decrease the effect of missing data.


CONCLUSIONS
Approximately 1 in 8 hospitalized patients with AD who develop delirium will have at least 1 adverse outcome, including death, institutionalization, or cognitive decline, associated with delirium. Delirium prevention may represent an important strategy for reducing adverse outcomes in this population.
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USA. tfong@bidmc.harvard.edu
Tamara G
TG
Fong
Richard N
RN
Jones
Edward R
ER
Marcantonio
Douglas
D
Tommet
Alden L
AL
Gross
Daniel
D
Habtemariam
Eva
E
Schmitt
Liang
L
Yap
Sharon K
SK
Inouye
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D003072:Cognition Disorders / Q000150:complications; D003693:Delirium / Q000150:complications*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007326:Institutionalization; D008297:Male; D008404:Massachusetts; D009735:Nursing Homes; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk