title: Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients.
abstract: OBJECTIVE
  The risk of institutionalization and functional decline is substantial after a hip fracture. However, previous research has not established the extent to which delirium plays a contributory role.
  
  
  METHODS
  Using a prospective design, we studied 207 hip fracture patients aged 65 and older, home-dwelling before the fracture. Patients were screened daily for delirium using the Confusion Assessment Method. Proxy information on pre-fracture cognitive function and function in activities of daily living (ADL) was obtained using the Informant Questionnaire on Cognitive Decline in the Elderly, 16-item version, and the Barthel ADL Index. After 6months, the patients' functions in ADL measured by the Barthel ADL Index and place of living were registered.
  
  
  RESULTS
  Delirium was present in 80 patients (39%) during the hospital stay. After 6months, 33 (16%) were institutionalized. Delirium and lower Barthel ADL Index score were the main risk factors for institutionalization with an adjusted odds ratio (AOR) of 5.50 (95% CI=1.77-17.11) and 0.54 (95% CI=0.40-0.74) respectively. In patients able to return to their private home, the independent risk factors for functional decline were higher age (B=0.053, 95% CI=0.003-0.102) and delirium (B=0.768, 95% CI=0.039-1.497).
  
  
  CONCLUSIONS
  At 6month follow-up, delirium constitutes an independent risk factor for institutionalization and functional decline in hip fracture patients living at home prior to the fracture.
authors.affiliation: Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: mariakrogseth@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Krogseth
authors.affiliation: Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: t.b.wyller@medisin.uio.no.
authors.forename: Torgeir Bruun
authors.initials: TB
authors.lastname: Wyller
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Norway; Norwegian Centre for Ageing and Health, Oslo University Hospital, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Engedal
authors.affiliation: Department of Geriatric Medicine, Oslo University Hospital, Norway; Department of Cardiology, Ullevaal, Oslo University Hospital, Norway.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Juliebø
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D060825:Cognitive Dysfunction / Q000209:etiology*; D003693:Delirium / Q000209:etiology*; D005260:Female; D006620:Hip Fractures / Q000523:psychology*; D006801:Humans; D007326:Institutionalization; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Delirium; Elderly; Functional decline; Hip fracture; Institutionalization