title: Six-month outcomes of co-occurring delirium, depression, and dementia in long-term care.
abstract: OBJECTIVE
  To describe the 6-month outcomes of co-occurring delirium (full syndrome and subsyndromal symptoms), depression, and dementia in a long-term care (LTC) population.
  
  
  METHODS
  Observational, prospective cohort study with 6-month follow-up conducted from 2005 to 2009.
  
  
  METHODS
  Seven LTC facilities in the province of Quebec, Canada.
  
  
  METHODS
  Newly admitted and long-term residents recruited consecutively from lists of residents aged 65 and older admitted for LTC, with stratification into groups with and without severe cognitive impairment. The study sample comprised 274 residents with complete data at baseline on delirium, dementia, and depression.
  
  
  METHODS
  Outcomes were 6-month mortality, functional decline (10-point decline from baseline on 100-point Barthel scale), and cognitive decline (3-point decline on 30-point Mini-Mental State Examination). Predictors included delirium (full syndrome or subsyndromal symptoms, using the Confusion Assessment Method), depression (Cornell Scale for Depression in Dementia), and dementia (chart diagnosis).
  
  
  RESULTS
  The baseline prevalences of delirium, subsyndromal symptoms of delirium (SSD), depression, and dementia were 11%, 44%, 19%, and 66%, respectively. By 6 months, 10% of 274 had died, 19% of 233 had experienced functional decline, and 17% of 246 had experienced cognitive decline. An analysis using multivariable generalized linear models found the following significant interaction effects (P < .15): between depression and dementia for mortality, between delirium and depression for functional decline, and between SSD and dementia for cognitive decline.
  
  
  CONCLUSIONS
  Co-occurrence of delirium, SSD, depression, and dementia in LTC residents appears to affect some 6-month outcomes. Because of limited statistical power, it was not possible to draw conclusions about the effects of the co-occurrence of some syndromes on poorer outcomes.
authors.affiliation: St. Mary's Research Centre, St Mary's Hospital Center, Montreal; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec.
authors.forename: Jane
authors.initials: J
authors.lastname: McCusker
authors.forename: Martin G
authors.initials: MG
authors.lastname: Cole
authors.forename: Philippe
authors.initials: P
authors.lastname: Voyer
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.forename: Nathalie
authors.initials: N
authors.lastname: Champoux
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciampi
authors.forename: Minh
authors.initials: M
authors.lastname: Vu
authors.forename: Eric
authors.initials: E
authors.lastname: Belzile
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000150:complications* / Q000628:therapy*; D003704:Dementia / Q000150:complications* / Q000628:therapy*; D003863:Depression / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D011446:Prospective Studies; D011792:Quebec; D016896:Treatment Outcome
keywords: aging; cognitive decline; delirium; dementia; depression; functional decline; long-term care; mortality