Dementia and delirium, the outcomes in elderly hip fracture patients.
BACKGROUND
Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium.


METHODS
This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes.


RESULTS
Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%,P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%).


CONCLUSIONS
Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.
Department of Surgery, Amphia Hospital, Breda.
Christina A
CA
Mosk
Department of Surgery, Amphia Hospital, Breda.
Marnix
M
Mus
Department of Surgery, Amphia Hospital, Breda.
Jos Pam
JP
Vroemen
Department of Public Health, Erasmus MC-University Medical Center, Rotterdam.
Tjeerd
T
van der Ploeg
Department of Surgery, Amphia Hospital, Breda.
Dagmar I
DI
Vos
Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands.
Leon Hgj
LH
Elmans
Department of Surgery, Amphia Hospital, Breda.
Lijckle
L
van der Laan
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D001803:Blood Transfusion; D015897:Comorbidity; D003693:Delirium / Q000453:epidemiology*; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly; D006454:Hemoglobins; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
D006454:Hemoglobins
adverse outcomes; complications; delirium; dementia; elderly; hip fracture