The 6-and 12-Month Outcomes of Older Medical Inpatients Who Recover from Subsyndromal Delirium

Department of Psychiatry, St. Mary's Hospital Center, Montreal, Quebec, Canada.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 12/2008; 56(11):2093-9. DOI: 10.1111/j.1532-5415.2008.01963.x
Source: PubMed

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.

Download full-text


Available from: Antonio Ciampi, Jul 06, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: one explanation for the poor prognosis of delirium among older hospital patients may be that many of these patients do not recover from delirium. We sought to determine the frequency and prognosis of persistent delirium (PerD) in older hospital patients by systematically reviewing original research on this topic. MEDLINE, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles. The bibliographies of relevant articles were searched for additional references. Eighteen reports (involving 1,322 patients with delirium) met the following seven inclusion criteria: original research published in English or French, prospective study design, study population of at least 20 hospital patients, patients aged 50 years or more, follow-up of at least 1 week, acceptable definition of delirium at enrollment and included at least one assessment for PerD at discharge or later. The methods of each study were assessed according to the six criteria for prognostic studies described by the Evidence-Based Medicine Working Group. Information about the sample origin and size, age, proportion with dementia, criteria for delirium, timing of follow-up assessments, criteria for PerD, proportion with PerD and prognosis of PerD was systematically abstracted from each report, tabulated and combined using standard meta-analysis techniques. the combined proportions with PerD at discharge, 1, 3 and 6 months were 44.7% (95% CI 26.8%, 63.7%), 32.8% (95% CI 18.4%, 47.2%), 25.6% (95% CI 7.9%, 43.4%) and 21% (95% CI 1.4%, 40.6%), respectively. The outcomes (mortality, nursing home placement, function, cognition) of patients with PerD were consistently worse than the outcomes of patients who had recovered from delirium. PerD in older hospital patients is frequent, appears to be associated with adverse outcomes and may account for the poor prognosis of delirium in this population. These findings have potentially important implications for clinical practice and research.
    Age and Ageing 12/2008; 38(1):19-26. DOI:10.1093/ageing/afn253 · 3.11 Impact Factor
  • International Psychogeriatrics 05/2009; 21(4):613-5. DOI:10.1017/S1041610209008989 · 1.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm. Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers. It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures. Limitations: No sufficiently validated diagnostic instrument covering the entire algorithm is available yet. This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.
    Intensive Care Medicine 09/2009; 35(11):1843-9. DOI:10.1007/s00134-009-1652-8 · 7.21 Impact Factor
Show more