Time of <b><i>delirium</i></b> onset and prognosis amongst Southern Brazilian hospitalized elderly patients

Moschetta, André Luiz; Silveira, Carine Volkweis; Dalacorte, Roberta Rigo; Schneider, Rodolfo Herberto; Silva Filho, Irênio Gomes da

doi:10.1590/S1980-57642009DN30400007

Abstract

The prognostic significance of delirium in hospitalized elderly has not yet been fully clarified.

Objectives:

The present study was designed to evaluate the relationship between prevalent delirium (PrD), incident delirium (InD) and final outcome.

Methods:

A historical cohort of 261 patients was selected. delirium was diagnosed using the Confusion Assessment Method.

Results:

The total frequency of delirium detected was 42.5%-31.4% PrD and 16.2% InD. Among patients with InD, the average length of hospital stay was 9.1 days longer than for patients without delirium (p=0.002), and the hospital mortality associated with InD was 48% versus 2.7% for those without delirium (p<0.001). However, no difference was observed between patients with PrD and those without delirium.

Conclusions:

These results suggest that, when investigating delirium and prognosis amongst hospitalized elderly, it is fundamental to differentiate in terms of time of onset. Furthermore, the absence of delirium seems to be an important protective factor.

Key words:
delirium; acute confusional state; elderly; prognostic; hospitalization.

Resumo

O significado do prognóstico de delirium em idosos hospitalizados ainda não está completamente elucidado.

Objetivos:

O presente estudo foi designado para avaliar a relação entre delirium prevalente (DeP), delirium incidente (DeI) e o desfecho final.

Métodos:

Uma coorte histórica de 261 pacientes foi selecionada. delirium foi diagnosticado pelo Confusion Assessment Method.

Resultados:

A freqüência total de delirium foi de 42.5%, DeP 31.4%, e DeI 16.2%. Para pacientes com DeI, a média de duração de hospitalização foi 9.1 dias maior do que aqueles sem delirium (p=0.002), e a mortalidade hospitalar associada a DeI foi de 48.3% contra 2.7% dos livres de delirium (p<0.001). Contudo, não houve diferença entre pacientes com DeP e sem delirium.

Conclusões:

Os resultados sugerem que, ao estudar delirium e prognóstico entre idosos hospitalizados, é fundamental diferenciar o problema quanto ao seu momento de início. Além disso, não apresentar delirium parece constituir-se num fator protetor importante.

Palavras-chave:
delirium; estado confusional agudo; idoso; prognóstico; hospitalização.

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Full text available only in PDF format.

References

¹
Projeções e estimativas demográficas (2001-2006). Instituto Brasileiro de Geografia e Estatística (IBGE) http://www.ibge.gov.br Access date April 2009.
» http://www.ibge.gov.br
²
Castro M. A utilização das internações hospitalares no Brasil: fatores associados, grandes usuários, reinternações e efeito da oferta de serviços sobre o uso. Rio de Janeiro: Escola Nacional de Saúde Pública da Fundação Osvaldo Cruz; 2004:101.
³
Meneghell S, Armani T, Rosa R et al. Internações hospitalares no Rio Grande do Sul. Informe Epidemiológico do SUS 1997;6:49-59.
⁴
Loyola Filho A, Matos D, Giatti L, et al. Causas de internações hospitalares entre idosos brasileiros no âmbito do Sistema Único de Saúde. Epidemiologia e Serviços de Saúde 2004;13:229-238.
⁵
Lipowski ZJ. Delirium (acute confusional states). JAMA 1987; 258:1789-1792.
⁶
Fabbri R. Delirium. In: Freitas E, Py L, Cançado F, Doll J, Gorzoni M, editors. Tratado de Geriatria e Gerontologia, 2nd. Rio de Janeiro: Guanabara Koogan; 2006:325-332.
⁷
Agostini J, Inouye S. Delirium. In: Hazzard W, Blass J, Halter J, Ouslander J, Tinetti M, editors. Principles of Geriatric Medicine and Gerontology, 5th. New York: McGraw-Hill; 2003: 1503-1515.
⁸
Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med 1982;16:1033-1038.
⁹
Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999;106:565-573.
¹⁰
Inouye SK. Delirium in older persons. N Engl J Med 2006;354: 1157-1165.
¹¹
Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097-1101.
¹²
Lawlor PG, Gagnon B, Mancini IL et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000;160: 786-794.
¹³
Pisani MA, McNicoll L, Inouye SK. Cognitive impairment in the intensive care unit. Clin Chest Med 2003;24:727-737.
¹⁴
Kakuma R, du Fort GG, Arsenault L et al. Delirium in older emergency department patients discharged home: effect on survival. J Am Geriatr Soc 2003;51:443-450.
¹⁵
Inouye SK, Bogardus ST, Jr. Charpentier PA et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669-676.
¹⁶
Cole MG, Primeau FJ. Prognosis of delirium in elderly hospital patients. CMAJ 1993;149:41-46.
¹⁷
Pompei P, Foreman M, Rudberg MA, et al. Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc 1994;42:809-815.
¹⁸
O'Keeffe S, Lavan J. The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 1997;45:174-178.
¹⁹
Adamis D, Treloar A, Darwiche FZ, et al. Associations of delirium with in-hospital and in 6-months mortality in elderly medical inpatients. Age Ageing 2007;36:644-649.
²⁰
Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 2006;35:350-364.
²¹
Adamis D, Treloar A, Martin FC, et al. Recovery and outcome of delirium in elderly medical inpatients. Arch Gerontol Geriatr 2006;43:289-298.
²²
Formiga F, Marcos E, Sole A, et al. Acute confusional syndrome in elderly patients hospitalized due to medical condition. Rev Clin Esp 2005;205:484-488.
²³
Bellelli G, Frisoni GB, Turco R, et al. Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility. J Gerontol A Biol Sci Med Sci 2007;62:1306-1309.
²⁴
McCusker J, Cole MG, Dendukuri N, et al. Does delirium increase hospital stay? J Am Geriatr Soc 2003;51:1539-1546.
²⁵
Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994;97: 278-288.
²⁶
Fabbri RM, Moreira MA, Garrido R, et al. Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly. Arq Neuropsiquiatr 2001;59:175-179.
²⁷
Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941-948.
²⁸
Edlund A, Lundstrom M, Karlsson S, et al. Delirium in older patients admitted to general internal medicine. J Geriatr Psychiatry Neurol 2006;19:83-90.
²⁹
Bellelli G, Morghen S, Turco R, et al. Delirium in older people: an epiphenomenon of incipient death or a separate biological process? Age Ageing 2008;37:353-354; author reply 355.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
29 Sept 2009
Accepted
16 Nov 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Projeções e estimativas demográficas (2001-2006). Instituto Brasileiro de Geografia e Estatística (IBGE) http://www.ibge.gov.br Access date April 2009.
» http://www.ibge.gov.br

[2] ²
Castro M. A utilização das internações hospitalares no Brasil: fatores associados, grandes usuários, reinternações e efeito da oferta de serviços sobre o uso. Rio de Janeiro: Escola Nacional de Saúde Pública da Fundação Osvaldo Cruz; 2004:101.

[3] ³
Meneghell S, Armani T, Rosa R et al. Internações hospitalares no Rio Grande do Sul. Informe Epidemiológico do SUS 1997;6:49-59.

[4] ⁴
Loyola Filho A, Matos D, Giatti L, et al. Causas de internações hospitalares entre idosos brasileiros no âmbito do Sistema Único de Saúde. Epidemiologia e Serviços de Saúde 2004;13:229-238.

[5] ⁵
Lipowski ZJ. Delirium (acute confusional states). JAMA 1987; 258:1789-1792.

[6] ⁶
Fabbri R. Delirium. In: Freitas E, Py L, Cançado F, Doll J, Gorzoni M, editors. Tratado de Geriatria e Gerontologia, 2nd. Rio de Janeiro: Guanabara Koogan; 2006:325-332.

[7] ⁷
Agostini J, Inouye S. Delirium. In: Hazzard W, Blass J, Halter J, Ouslander J, Tinetti M, editors. Principles of Geriatric Medicine and Gerontology, 5th. New York: McGraw-Hill; 2003: 1503-1515.

[8] ⁸
Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med 1982;16:1033-1038.

[9] ⁹
Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 1999;106:565-573.

[10] ¹⁰
Inouye SK. Delirium in older persons. N Engl J Med 2006;354: 1157-1165.

[11] ¹¹
Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097-1101.

[12] ¹²
Lawlor PG, Gagnon B, Mancini IL et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000;160: 786-794.

[13] ¹³
Pisani MA, McNicoll L, Inouye SK. Cognitive impairment in the intensive care unit. Clin Chest Med 2003;24:727-737.

[14] ¹⁴
Kakuma R, du Fort GG, Arsenault L et al. Delirium in older emergency department patients discharged home: effect on survival. J Am Geriatr Soc 2003;51:443-450.

[15] ¹⁵
Inouye SK, Bogardus ST, Jr. Charpentier PA et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669-676.

[16] ¹⁶
Cole MG, Primeau FJ. Prognosis of delirium in elderly hospital patients. CMAJ 1993;149:41-46.

[17] ¹⁷
Pompei P, Foreman M, Rudberg MA, et al. Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc 1994;42:809-815.

[18] ¹⁸
O'Keeffe S, Lavan J. The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 1997;45:174-178.

[19] ¹⁹
Adamis D, Treloar A, Darwiche FZ, et al. Associations of delirium with in-hospital and in 6-months mortality in elderly medical inpatients. Age Ageing 2007;36:644-649.

[20] ²⁰
Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 2006;35:350-364.

[21] ²¹
Adamis D, Treloar A, Martin FC, et al. Recovery and outcome of delirium in elderly medical inpatients. Arch Gerontol Geriatr 2006;43:289-298.

[22] ²²
Formiga F, Marcos E, Sole A, et al. Acute confusional syndrome in elderly patients hospitalized due to medical condition. Rev Clin Esp 2005;205:484-488.

[23] ²³
Bellelli G, Frisoni GB, Turco R, et al. Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility. J Gerontol A Biol Sci Med Sci 2007;62:1306-1309.

[24] ²⁴
McCusker J, Cole MG, Dendukuri N, et al. Does delirium increase hospital stay? J Am Geriatr Soc 2003;51:1539-1546.

[25] ²⁵
Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994;97: 278-288.

[26] ²⁶
Fabbri RM, Moreira MA, Garrido R, et al. Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly. Arq Neuropsiquiatr 2001;59:175-179.

[27] ²⁷
Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941-948.

[28] ²⁸
Edlund A, Lundstrom M, Karlsson S, et al. Delirium in older patients admitted to general internal medicine. J Geriatr Psychiatry Neurol 2006;19:83-90.

[29] ²⁹
Bellelli G, Morghen S, Turco R, et al. Delirium in older people: an epiphenomenon of incipient death or a separate biological process? Age Ageing 2008;37:353-354; author reply 355.

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