DOES DELIRIUM CONTRIBUTE TO POOR HOSPITAL OUTCOMES - A 3-SITE EPIDEMIOLOGIC-STUDY

OBJECTIVE: To determine the independent contribution of admission deli rium to hospital outcomes including mortality, institutionalization, a nd functional decline. DESIGN: Three prospective cohort studies. SETTI NG: Three university-affiliated teaching hospitals. PATIENTS: Consecut ive samples of 727 patients, aged 65 years and older. MEASUREMENTS AND MAIN RESULTS: Delirum was present at admission in 88 (12%) of 727 pat ients. The main outcome measures at hospital discharge and 3-month fol low-up were death, new nursing home placement, death or new nursing ho me placement, and functional decline. At hospital discharge, new nursi ng home placement occurred in 60 (9%) of 692 patients, and the adjuste d odds ratio (OR) for delirium, controlling for baseline covariates of age, gender, dementia, APACHE II score, and functional measures, was 3.0, (95% confidence interval [CI] 1.4, 6.2). Death or new nursing hom e placement occurred in 95 (13%) of 727 patients (adjusted OR far deli rium 2.1, 95% CI 1.1, 4.0). The findings were replicated across all si tes. The associations between delirium and death alone (in 35 [5%] of 727 patients) and between delirium and length of stay were not statist ically significant. At 3-month follow-up, new nursing home placement o ccurred in 77 (13%) of 600 patients (adjusted OR for delirium 3.0; 95% CI 1.5, 6.0). Death or new nursing home placement occurred in 165 (25 %) of 663 patients (adjusted OR for delirium 2.6; 95% CI 1.4, 4.5). Th e findings were replicated across all sites. For death alone (in 98 [1 4%] of 680 patients), the adjusted OR for delirium was 1.6 (95% CI 0.8 , 3.2). Delirium was a significant predictor of functional decline at both hospital discharge (adjusted OR 3.0: 95% CI 1.6, 5.8) and follow- up (adjusted OR 2.7: 95% CI 1.4, 5.2). CONCLUSIONS: Delirium is an imp ortant independent prognostic determinant of hospital outcomes includi ng new nursing home placement, death or new nursing home placement, an d functional decline - even after controlling for age, gender, dementi a, illness severity, and functional status. Thus, delirium should be c onsidered as a prognostic variable in case-mix adjustment systems and in studies examining hospital outcomes in older persons.