title: Prospective observational study of delirium recovery trajectories and associated short-term outcomes in older adults admitted to a specialized delirium unit.
abstract: OBJECTIVE
  To describe the recovery trajectories of delirium and to determine factors predicting the course of recovery and adverse outcome.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  Geriatric monitoring unit (GMU), a five-bed unit specializing in managing older adults with delirium.
  
  
  METHODS
  Individuals admitted to the GMU between December 2010 and August 2012 (N = 234; mean age 84.1 ± 7.4).
  
  
  METHODS
  Information was collected on demographic characteristics; comorbidities; severity of illness; functional status; and daily cognitive, Delirium Rating Scale, Revised-98 (DRS-R98) severity, and functional scoring. Resolution of delirium, and thus GMU discharge, was determined according to clinical assessment. The primary outcome was residual subsyndromal delirium (SSD) (DRS-R98 severity ≥13) upon GMU discharge. Univariate and multivariate methods were used to determine the predictors of residual SSD and adverse outcomes (inpatient mortality and incident nursing home admission upon discharge).
  
  
  RESULTS
  Participants with residual SSD had a slower recovery in terms of delirium severity, cognition, and functional status than those with no residual SSD. Residual SSD predictors included underlying dementia, admission DRS-R98 severity, DRS-R98 severity on Day 1 minus Day 3 of GMU stay, and admission modified Barthel Index. Only presence of residual SSD at discharge predicted adverse outcomes (odds ratio = 5.27, 95% confidence interval = 1.43-19.47).
  
  
  CONCLUSIONS
  Individuals with residual SSD had prolonged recovery trajectory of delirium. These new insights into the recovery trajectories of delirium may help formulate early discharge planning and provide the basis for future research on delirium treatment.
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
authors.forename: Ching-yu
authors.initials: CY
authors.lastname: Lam
authors.forename: Laura
authors.initials: L
authors.lastname: Tay
authors.forename: Mark
authors.initials: M
authors.lastname: Chan
authors.forename: Yew Yoong
authors.initials: YY
authors.lastname: Ding
authors.forename: Mei Sian
authors.initials: MS
authors.lastname: Chong
mesh_terms: D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology* / Q000628:therapy*; D003704:Dementia / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009483:Neuropsychological Tests; D009735:Nursing Homes; D010351:Patient Discharge; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology
keywords: mortality; outcomes; subsyndromal delirium