title: Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults.
abstract: BACKGROUND
  Current literature does not identify the significance of underlying cognitive impairment and delirium in older adults during and 30 days following acute care hospitalization.
  
  
  OBJECTIVE
  Describe the incidence, risk factors, and outcomes associated with incident delirium superimposed on dementia.
  
  
  METHODS
  A 24-month prospective cohort study.
  
  
  METHODS
  Community hospital.
  
  
  METHODS
  A total of 139 older adults (>65 years) with dementia.
  
  
  METHODS
  This prospective study followed patients daily during hospitalization and 1 month posthospital. Main measures included dementia (Modified Blessed Dementia Rating score, Informant Questionnaire on Cognitive Decline in the Elderly), daily mental status change, dementia stage/severity (Clinical Dementia Rating, Global Deterioration Scale), delirium (Confusion Assessment Method), and delirium severity (Delirium Rating Scale-Revised-98). All statistical analysis was performed using SAS 9.3, and significance was an α level of 0.05. Logistic regression, analysis of covariance, or linear regression was performed controlling for age, gender, and dementia stage.
  
  
  RESULTS
  The overall incidence of new delirium was 32% (44/139). Those with delirium had a 25% short-term mortality rate, increased length of stay, and poorer function at discharge. At 1 month follow-up, subjects with delirium had greater functional decline. Males were more likely to develop delirium, and for every 1 unit increase in dementia severity (Global Deterioration Scale), subjects were 1.5 times more likely to develop delirium.
  
  
  CONCLUSIONS
  Delirium prolongs hospitalization for persons with dementia. Thus, interventions to increase early detection of delirium have the potential to decrease the severity and duration of delirium and to prevent unnecessary suffering and costs from the complications of delirium and unnecessary readmissions to the hospital.
authors: School of Nursing, The Pennsylvania State University, University Park, Pennsylvania; Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
authors: Donna M
authors: DM
authors: Fick
authors: Melinda R
authors: MR
authors: Steis
authors: Jennifer L
authors: JL
authors: Waller
authors: Sharon K
authors: SK
authors: Inouye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
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