title: Affective functioning after delirium in elderly hip fracture patients.
abstract: BACKGROUND
  Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied.
  
  
  METHODS
  For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge.
  
  
  RESULTS
  Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups.
  
  
  CONCLUSIONS
  This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.
authors.affiliation: Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands. c.slor@mca.nl
authors.forename: Chantal J
authors.initials: CJ
authors.lastname: Slor
authors.forename: Joost
authors.initials: J
authors.lastname: Witlox
authors.forename: René W M M
authors.initials: RW
authors.lastname: Jansen
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Adamis
authors.forename: David J
authors.initials: DJ
authors.lastname: Meagher
authors.forename: Esther
authors.initials: E
authors.lastname: Tieken
authors.forename: Alexander P J
authors.initials: AP
authors.lastname: Houdijk
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Gool
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
authors.forename: Jos F M
authors.initials: JF
authors.lastname: de Jonghe
mesh_terms: D000203:Activities of Daily Living; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications* / Q000523:psychology; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000523:psychology / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000523:psychology; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome