Association Between Psychomotor Activity Delirium Subtypes and Mortality Among Newly Admitted Postacute Facility Patients

Hebrew SeniorLife, Institute for Aging Research, Boston, MA 02131, USA.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences (Impact Factor: 5.42). 03/2007; 62(2):174-9. DOI: 10.1093/gerona/62.2.174
Source: PubMed

ABSTRACT Delirium is common among hospitalized elders and may persist for months. Therefore, the adverse impact of delirium on independence often occurs in the post acute care (PAC) setting. The effect of psychomotor subtypes on delirium remains uncertain. The purpose of this study is to examine the association between psychomotor activity delirium subtypes and 1-year mortality among 457 newly admitted delirious PAC patients.
Patients were screened for delirium on admission to PAC facilities after an acute hospitalization, and patients with "Confusion Assessment Method"-defined delirium were enrolled. Psychomotor activity was assessed using the Memorial Delirium Assessment Scale, and patients were classified as to their delirium subtype (hyperactive, hypoactive, mixed, or normal). One-year mortality data were obtained from the National Death Index. A Kaplan-Meier survival analysis and a proportional hazards analysis using indicator (dummy) variables with normal psychomotor activity as the referent were performed.
The normal psychomotor activity group had the lowest 1-year mortality rate, followed by the hyperactive, mixed, then hypoactive groups in increasing order. Independent of age, gender, comorbidity, dementia, and delirium severity, hypoactive patients were 1.60 (95% confidence interval [CI], 1.09-2.35) times more likely to die during the 1-year follow-up period than were patients with normal psychomotor activity. The hyperactive (hazard ratio = 1.30; 95% CI, 0.73-2.31) and mixed (hazard ratio = 1.25; 95% CI, 0.72-2.17) psychomotor groups had nonsignificant elevated risks relative to the normal psychomotor behavior group.
All three psychomotor disturbance subtypes had an elevated risk of dying during the 1-year follow-up relative to the normal psychomotor group, though the hypoactive group had the highest mortality risk and was the only group with a statistically significantly elevated risk relative to the normal group.

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    • "It has been reported that hypoactive patients are more likely to develop pressure sores or hospital-acquired infections, while falls are most likely in patients with hyperactive delirium [14]. Regarding prognostic significance of delirium subtypes studies have yielded contradictory results [13], but there is some evidence that hypoactive patients may have higher mortality risk compared to other psychomotor activity patient groups [15]. There is an ongoing research on delirium subtypes and here we intend to provide an up-to-date review of the recent literature focused on hypoactive delirium (HD). "
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    ABSTRACT: Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research.
    Behavioural neurology 09/2015; 2015:416792. DOI:10.1155/2015/416792 · 1.45 Impact Factor
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    • "In general, it can be concluded that all these associations possibly reflect poor knowledge or awareness among physicians and surgeons about the signs and symptoms, and predictors of outcome of delirium. Studies have shown that older age and hypoactivity are associated with lower rates of detection of delirium[2021] and hypoactivity is associated with higher rates of mortality in patients of delirium.[2223] Data also suggest that longer duration of delirium is associated with higher rates of mortality during the hospitalization[24] and the subsequent 1 year.[25] "
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    ABSTRACT: Objective: To evaluate the predictors of delay in psychiatry referral for patients with delirium. Materials and Methods: The consultation liaison psychiatry registry and case notes of 461 patients referred to psychiatry consultation liaison services and diagnosed as having delirium were reviewed. Data pertaining to sociodemographic variables, clinical variables, Delirium Rating Scale-Revised 98 version, etiologies associated with delirium were extracted. Results: Older age, presence of and higher severity of sleep disturbance, presence of and higher severity of motor retardation, presence of visuospatial disturbances, presence of fluctuation of symptoms, being admitted to medical ward/medical intensive care units, and absence of comorbid axis-1 psychiatry diagnoses were associated with longer duration of psychiatric referral after the onset of delirium. Of these only four variables (presence of sleep disturbance, presence of motor retardation, being admitted to medical ward intensive care units and absence of comorbid axis-1 psychiatry diagnoses) were associated with longer duration of psychiatric referral in the regression analysis. Conclusion: The variables associated with delay in psychiatry referral for delirium suggest that there is a need to improve the understanding of the physicians and surgeons about the signs and symptoms, risk factors, and prognostic factors of delirium.
    Indian Journal of Psychiatry 04/2014; 56(2):171-5. DOI:10.4103/0019-5545.130501
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    • "Previous studies have found different results concerning the etiology, occurrence, characteristics and outcomes associated with motor subtypes [4]. Some suggest that hypoactive delirium is associated with poorer prognosis [5] [6] while others suggest poorer outcomes for patients with hyperactive or mixed subtype, or no difference in outcomes [7] [8] [9] [10] [11]. Also, many patients with no motor subtype have less severe or subsyndromal delirium [12]. "
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    ABSTRACT: Objective: Delirium is often accompanied by changes in motor activity but the longitudinal expression of these features and etiological and prognostic significance of clinical subtypes defined by motor activity is unclear. Methods: This is a prospective cohort study of elderly patients undergoing hip fracture surgery. Baseline characteristics were assessed preoperatively. During hospital admission presence of delirium was assessed daily according to CAM criteria. This study compared baseline characteristics and outcomes according to a longitudinal pattern of motor subtype expression (predominantly hyperactive, predominantly hypoactive, predominantly mixed, no motor subtype and variable). Motor subtype categorization was performed with the DRS-R98. We also investigated the longitudinal stability of motor subtypes across the delirium episode. Results: 62 patients had experienced in-hospital delirium postoperatively. The full course of the delirium episode could be defined for 42/62 (67.7%) patients. Of the patients with multiple days of delirium only 4/30 (13.3%) patients had a consistent motor subtype profile throughout the delirium episode, while 26/30 (86.7%) patients had a variable course. Of the patients with multiple days of delirium, 5/30 (16.7%) were predominantly hypoactive in profile, 7/30 (23.3%) predominantly hyperactive, 6/30 (20%) predominantly mixed, 1/30 (3.3%) had no motor subtype and 11/30 (36.7%) had a variable profile. Baseline characteristics and outcomes did not differ between the groups. Conclusion: The majority of elderly hip fracture patients in this homogenous sample experienced variable expression of motor subtype over the course of their delirium episodes. The subtype categorization according to dominant motor subtype across the delirium episode identified groups with similar characteristics and outcomes.
    Journal of psychosomatic research 05/2013; 74(5):444-449. DOI:10.1016/j.jpsychores.2012.12.007 · 2.74 Impact Factor
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