THE PROGNOSTIC-SIGNIFICANCE OF DELIRIUM IN OLDER HOSPITAL PATIENTS

OBJECTIVES: To determine whether delirium is an independent predictor of adverse outcomes of hospitalization in older patients. DESIGN: Coho rt study PATIENTS: A total of 225 people admitted as an emergency to a n acute geriatric unit in a university teaching hospital METHODS: Subj ects were screened for delirium, defined by Diagnostic and Statistical Manual, 3rd Edition criteria, every 48 hours. Outcome measures includ ed mortality, duration of hospital stay, hospital-acquired complicatio ns, and institutional placement. The influence of delirium on these ou tcomes was calculated after adjusting for age, illness severity on adm ission, burden of comorbidity, prior cognitive impairment, and level o f disability. RESULTS: Delirium was present on admission in 41 patient s (18%) and developed after admission in a further 53 patients (24%). Patients with delirium were more likely than nondelirious patients to have chronic cognitive impairment, severe acute illness, multiple como rbid conditions, and functional disability. Nevertheless, in multivari ate analyses adjusting for these factors, delirium was independently a ssociated with prolonged hospital stay, functional decline during hosp italization, increased risk of developing a hospital-acquired complica tion, and with increased admission to longterm care. CONCLUSION: Delir ium is an independent predictor of adverse outcomes in older hospital patients.