Comparison of Consecutive Periods of 1-, 2-, and 3-Year Mortality of Geriatric Inpatients with Delirium, Dementia, and Depression in a Consultation-Liaison Service
Dementia, depression, and delirium are the most prevalent psychiatric disorders in elderly medical inpatients and are all associated with higher mortality. The purpose of this study was to assess and compare consecutive periods of 1-, 2-, and 3-year mortality among elderly patients with dementia, depression, and delirium seen by a psychiatry consultation-liaison service in a general hospital. We consecutively enrolled inpatients 65 years of age and older that were referred for psychiatric consultation (N = 614) from 2002 to 2006: 172 were diagnosed with delirium, 92 with dementia, and 165 with depression. The 1-, 2-, and 3-year mortality rates for the three groups of patients were compared by log-rank test. The Cox proportional hazard regression model was used to identify any possible factors associated with mortality during the study period. Only 1-year mortality in the delirium group was significantly higher than that in the depression group (p < 0.05), but there was no significant difference among the three groups in 2- and 3-year mortality. In terms of gender, higher mortality was identified only in depressed male patients. Furthermore, male, older age, and longer length of hospital stay, but not multiple physical comorbidities, were associated with higher mortality. Clinical physicians should give special attention to delirious patients within the first year after referral. Patients at risk for mortality should be closely followed and early intervention provided in an effort to decrease or delay mortality.
[Show abstract] [Hide abstract] ABSTRACT: Although the brain is the target organ of general anaesthesia, the utility of intra-operative brain monitoring remains controversial. Ideally, the incorporation of brain monitoring into routine practice would promote the maintenance of an optimal depth of anaesthesia, with an ultimate goal of avoiding the negative outcomes that have been associated with inadequate or excessive anaesthesia. A variety of processed electroencephalogram devices exist, of which the bispectral index is the most widely used, particularly in the research setting. Whether such devices prove to be useful will depend not only on their ability to influence anaesthetic management but also on whether the changes they promote can actually affect clinically important outcomes. This review highlights the evidence for the role of bispectral index monitoring, in particular, in guiding anaesthetic management and influencing clinical outcomes, specifically intra-operative awareness, measures of early recovery, mortality and neurocognitive outcomes.0Comments 8Citations
- "Delirium is a common postoperative complication, affecting between 10% and 70% of patients older than 60 years who undergo major surgical procedures. It is a clinically important complication , is distressing to patients and their families, and is linked to increased costs and worse outcomes including mortality . There is mounting evidence from several randomised, controlled trials that a BIS-based protocol can decrease postoperative delirium, possibly by decreasing anaesthetic administration . "
- [Show abstract] [Hide abstract] ABSTRACT: Objective Delirium is a common acute neuropsychiatric disorder caused by a variety of physical insults. It is commonly associated with a variety of serious adverse outcomes, including elevated mortality. There are few studies of delirium occurring in psychiatric patients, including its mortality. The aim was to determine the psychiatric diagnostic profile of Danish psychiatric inpatients diagnosed with delirium and to compare standardized mortality ratio (SMR) in this group with the Danish population and general psychiatric inpatients from 1995 through 2012. Methods All first time ICD-10 diagnoses of delirium among psychiatric inpatients were identified in the nationwide Danish Psychiatric Central Research Register (DPCRR) from 1995 through 2012. Results A total of 7,179 persons diagnosed with delirium was identified in the DPCRR between 1995 and 2012. Of these patients 40.8% had more than one diagnosis of delirium during the period. We identified three distinct groups, based on the first delirium-diagnosis; unspecified delirium (76.9%), comorbid delirium-dementia (19.8%), and drug-related delirium (3.3%). Use of sedative-hypnotics was noted in 46% of those with drug-related delirium. The SMR of delirious psychiatric inpatients compared to all psychiatric inpatients was stable at 1.7 throughout the time period. Conclusion Delirium occurring in psychiatric inpatients is associated with elevated mortality. Sedative-hypnotic agents are commonly involved in drug-related delirium. Particular preventative effort is warranted for patients with a previous history of delirium, as we found approximately 40% with more than one episode of delirium.0Comments 0Citations
- [Show abstract] [Hide abstract] ABSTRACT: Summary Injury to the central and peripheral nervous systems is often permanent. As such, adverse neurological outcomes of surgery and anaesthesia can be devastating for patients and their families. In this article, we review the incidence, risk factors, outcomes, prevention, and treatment of a number of important neurological complications in the perioperative period. © 2014 The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.0Comments 8Citations