The 6- and 12-month outcomes of older medical inpatients who recover from subsyndromal delirium.
ABSTRACT To compare the 6- and 12-month outcomes of patients who recovered from subsyndromal delirium (SSD) by 8 weeks with the outcomes of patients who did not recover or did not have an index episode.
Secondary analysis of data collected for a cohort study of the prognosis of delirium.
University-affiliated primary acute care hospital.
Older medical inpatients with prevalent, incident, or no SSD were classified into three mutually exclusive groups at 8 weeks (SSD-recovered, SSD-not recovered, no SSD) and followed up at 6 and 12 months.
The primary hierarchical composite outcome was death, institutionalization, or cognitive or functional decline at 6 and 12 months. In secondary analyses, components of the primary outcome were examined separately.
Of the 129 patients assessed at 8 weeks, 51, 47, and 31 met criteria for SSD-recovered, SSD-not recovered and no SSD, respectively. At 6 and 12 months, the primary and secondary outcomes of the SSD-recovered group were better than the outcomes of the SSD-not recovered group and, for the most part, intermediate between the outcomes of the SSD-not recovered and no SSD groups.
Recovery from SSD appears to predict better longer-term outcomes than no recovery. Efforts to identify and treat SSD in older medical inpatients may improve outcomes.
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ABSTRACT: Delirium often presents difficult diagnostic and classification challenges in palliative care settings.Journal of Pain and Symptom Management 05/2014; · 2.74 Impact Factor
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ABSTRACT: In this systemic review, the articles published between1990 and November 2012 on subsyndromal delirium (SSD), and specifically those with reference to geriatric patients, were analysed. In SSD, symptoms from the three nuclear domains of delirium (cognitive, circadian and higher order thinking) are simultaneously present, with mild to moderate severity. Although the search for these clinical characteristics is a useful guide, there are no universally accepted diagnostic criteria for SSD. Regardless of the criteria used for diagnosis, SSD is persistently associated with poor functional and cognitive outcome, longer hospital stay, institutionalisation, and increased mortality. Studies are needed on the physiopathology, treatment and prevention in the field of SSD, which is a particularly important clinical condition in geriatric patients.Revista Española de Geriatría y Gerontología 05/2013; 48(3):122–129.
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ABSTRACT: IntroductionSubsyndromal delirium (SSD) is a developing concept of disease with a spectrum beyond the diagnostic dichotomy of delirium with standard criteria.Material and methodsTo study the prevalence and significance of SSD we have conducted a cross-sectional prospective multicenter study of all patients admitted to three Geriatric Departments in tertiary hospitals. The SSD diagnostic criteria used were based on Marcantoniós criteria, and the DRS-R-98 scale was also used as a continuous variable of the degree of delirium.ResultsWe studied 85 patients, 56% women, Barthel 62 (SD: 32), age 87 (SD: 6), CIRS-G 24 (SD: 6.85). Three quarters (75.3%) of patients had at least one CAM positive item, and half of them with at least 13 points in the DRS-R-98 scale. The prevalence of delirium was 53% and 22.3% for SSD. The degree of delirium-DSS was associated with different geriatric syndromes, levels of malnutrition, and degree of functional and cognitive impairment, with a significant linear trend between groups. Patients without delirium have higher levels than those with subsyndromal delirium, and these in turn are higher than those without diagnosed delirium. There is also a tendency in the degree of delirium measured by the DRS-R-98.Conclusion Beyond the dichotomous concept of the presence or absence of delirium, this study suggests the probable continuity of cognitive processes and the possibility of more effective and earlier diagnostic and therapeutic measuresRevista Española de Geriatría y Gerontología 07/2012; 47(4):158–161.