title: Functional improvement in hospitalized older adults is independent of dementia diagnosis: experience of a specialized delirium management unit.
abstract: BACKGROUND
  Patients with delirium, especially when superimposed on dementia, are at high risk of functional decline.
  
  
  OBJECTIVE
  To examine the influence of a multicomponent delirium management program, the geriatric monitoring unit (GMU), on functional progress of delirious older patients and the impact of underlying dementia on functional recovery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The GMU is a specialized 5-bed unit for the care of delirious older adults within an acute tertiary hospital.
  
  
  METHODS
  Patients aged 65 years and older with delirium.
  
  
  METHODS
  The GMU is a multifactorial delirium treatment program with core interventions focusing on early mobilization and rehabilitation.
  
  
  METHODS
  Baseline measures included delirium severity (Delirium Rating Scale-98 and Confusion Assessment Method severity), Chinese Mini-Mental State Examination, functional status (modified Barthel Index [MBI]), comorbidity (Charlson's), and illness severity (modified Severity of Illness Index). Patients with and without dementia were compared for recovery in cognitive scores and functional status.
  
  
  RESULTS
  Of 122 patients with delirium who were admitted to the GMU over a 1-year period, 82 (67.2%) had underlying dementia. There were no significant differences in age, gender, delirium severity, illness severity, cognitive performance, and functional status at admission to the GMU between groups, although patients with dementia had significantly higher comorbidity (Charlson's 2.27 vs 1.75, P = 0.05). Significant cognitive and functional improvement was observed for the entire GMU cohort, with demented and nondemented groups capable of functional recovery (MBI gain of 20.43 vs 17.35, respectively, P = 0.35).
  
  
  CONCLUSIONS
  Elderly patients with dementia recovering from delirium have comparable potential for functional recovery as their cognitively intact counterparts in a delirium management unit focused on geriatric nursing care and rehabilitation.
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. laura_tay@ttsh.com.sg
authors.forename: Laura
authors.initials: L
authors.lastname: Bee Gek Tay
authors.forename: Mark Peng
authors.initials: MP
authors.lastname: Chew Chan
authors.forename: Mei
authors.initials: M
authors.lastname: Sian Chong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003704:Dementia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006757:Hospital Units / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*