Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes.
OBJECTIVE
To identify the rate of delirium present during admission to postacute care (PAC) in the nursing home setting and to determine whether patients with delirium had higher risk for adverse outcomes.


METHODS
Retrospective cohort study.


METHODS
US Medicare- and Medicaid-certified nursing homes, 2011 to 2014.


METHODS
Individuals admitted to all US nursing homes for PAC, aged ≥65 years, and without prior history of nursing home residence (n = 5,588,702).


METHODS
Minimum Data Set (MDS) 3.0 admission assessments identified delirium based upon Confusion Assessment Method (CAM) items. Robust Poisson regression was used to calculate adjusted relative risks (aRRs) with 95% confidence intervals (CIs) for death following PAC admission, and for 30-day discharge outcomes including re-hospitalization from PAC, discharge home, and functional improvement.


RESULTS
Delirium was identified in 4.3% of new postacute nursing home admissions. Mortality within 30 days of PAC admission was observed in 16.3% of patients with delirium and 5.8% of patients without delirium (aRR = 2.27, CI = 2.24-2.30). The rate of 30-day readmission from PAC was 21.3% for patients with delirium compared with 15.1% among patients without delirium (aRR = 1.42, 95% CI = 1.40, 1.43). 26.9% of patients with delirium were discharged home within 30 days of admission compared to 52.5% of patients without delirium (aRR = 0.57, 95% CI = 0.57, 0.58). 48.9% of patients with delirium showed functional improvement at discharge compared to 59.9% of patients without delirium (aRR = 0.83, 95% CI = 0.82, 0.83).


CONCLUSIONS
Patients with delirium present upon PAC admission were at high risk for mortality and 30-day re-hospitalization and were less likely to have timely discharge to home or to improve in physical function at discharge. Early identification and care planning for individuals with delirium at PAC admission may be essential to improve outcomes.
Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island.
Cyrus M
CM
Kosar
Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island.|Department of Veteran Affairs Medical Center, Providence, Rhode Island.
Kali S
KS
Thomas
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
Sharon K
SK
Inouye
Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island.|Department of Veteran Affairs Medical Center, Providence, Rhode Island.
Vincent
V
Mor
D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D019467:Subacute Care; D011795:Surveys and Questionnaires; D014481:United States
delirium; nursing homes; postacute care