Hospital admission and the occurrence of delirium in older adults with physical frailty: cross-sectional study

Rodrigues, João Alberto Martins; Lenardt, Maria Helena; Cechinel, Clovis; Cruz, Elaine Drehmer de Almeida; Tsunoda, Audrey Tieko; Kuznier, Tatiane Prette

doi:10.1590/1980-220X-REEUSP-2023-0156en

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0156en copy

Hospital admission and the occurrence of delirium in older adults with physical frailty: cross-sectional study^* * Extracted from the thesis: “Internação hospitalar e a ocorrência de delirium em idosos na condição de fragilidade física: estudo transversal”, Universidade Federal do Paraná, 2022.

Ingreso hospitalario y aparición de delirio en adultos mayores con fragilidad física: estudio transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze the relationship between hospitalization and the occurrence of delirium in older adults with physical frailty.

Method

Cross-sectional study carried out in a public hospital in southern Brazil. Hospitalized older adults aged ≥ 60 years participated. Sociodemographic and clinical data were collected, physical frailty phenotype tests were performed and the Confusion Assessment Method was used. Descriptive analyzes were carried out and odds ratio values were estimated for the frailty and delirium variables.

Results

Of the 320 older adults evaluated, 21.14% presented delirium, 49% were identified as pre-frail and 36.2% as frail. Of those affected by delirium, 71.6% were classified as frail and 28.3% as pre-frail (p < 0.001). An association was observed between the occurrence of delirium and frailty (OR 1.22; 95% CI 1.07 to 1.38), age ≥ 80 years (OR 1.14; 95% CI 1.01 to 1.32), epilepsy (OR 1.38; 95% CI 1.09 to 1.76), dementia (OR 1.58; 95% CI 1.37 to 1.82), and history of stroke (OR 1.14; 95% CI 1.03 to 1.26).

Conclusion

There was a high frequency of pre-frail and frail older adults, and the occurrence of delirium in frail was significantly higher. Special attention should be paid to frail older adults to prevent the occurrence of delirium during hospitalization.

DESCRIPTORS
Frail Elderly; Hospitalization; Delirium; Cross-sectional Studies

	TOTAL
	n = 320	95%CI^* *95% CI – 95% Confidence Interval; (SD)^† †SD – Standard Deviation; LTCF – Long-Term Care Facility.
Sex
Female	190	59.4% (53.9–64.6)
Male	130	40.6% (35.4–46.1)
Age
60–70	86	26.9% (22.3–32.0)
70–80	103	32.2% (27.3–37.5)
80 or more	131	40.9% (35.7–46.4)
Education
Illiterate	59	18.4% (14.6–23.1)
Literate (did not attend school)	37	11.6% (8.5–15.5)
Incomplete primary school	116	36.2% (31.2–41.7)
Primary school	65	20.3% (16.3–25.1)
Incomplete secondary school	10	3.1% (1.7–5.7)
Secondary school	22	6.9% (4.6–10.2)
Incomplete higher education	2	0.6% (0.2–2.2)
Higher education	9	2.8% (1.5–5.3)
Color
White	226	70.6% (65.4–75.3)
Brown/mixed race	68	21.2% (17.1–26.1)
Black	23	7.2% (4.8–10.6)
Yellow/Asian	3	0.9% (0.3–2.7)
Marital status
Single	17	5.3% (3.3–8.3)
Married	131	40.9% (35.7–46.4)
Divorced	37	11.6% (8.5–15.5)
Widowed	135	42.2% (36.9–47.7)
Residing with
Spouse and/or children	235	73.4% (68.3–78.0)
Parents and/or siblings	9	2.8% (1.5–5.3)
Alone	47	14.7% (11.2–19.0)
LTCF	12	3.8% (2.2–6.4)
Others	17	5.3% (3.3–8.3)
Professional situation
Working	18	5.6% (3.6–8.7)
Retiree	214	66.9% (61.5–71.8)
Pensioner/on benefits Social assistance	65	20.3% (16.3–25.1)
Home worker	11	3.4% (1.9–6.0)
Unemployed	12	3.8% (2.2–6.4)
Older adult income (minimum wage)
No income	17	5.3% (3.3–8.3)
0–1	127	39.7% (34.5–45.1)
1–3	120	37.5% (32.4–42.9)
3–5	27	8.4% (5.9–12.0)
5–10	5	1.6% (0.7–3.6)
More than 10	1	0.3% (0.1–1.7)
Did not inform	23	7.2% (4.8–10.6)
Family income (minimum wage)
No income	1	0.3% (0.1–1.7)
0–1	35	10.9% (8.0–14.8)
1–3	89	27.8% (23.2–33.0)
3–5	75	23.4% (19.1–28.4)
5–10	16	5% (3.1–8.0)
More than 10	3	0.9% (0.3–2.7)
Did not inform	101	31.6% (26.7–36.8)
Companion’s degree of kinship
Spouse and/or children	140	43.8% (38.4–49.2)
Parents and/or siblings	3	0.9% (0.3–2.7)
Alone	117	36.6% (31.5–42.0)
Professional caregiver	7	2.2% (1.1–4.4)
Others	53	16.6% (12.9–21.0)
Type of current hospitalization
Clinical	295	92.2% (88.7–94.7)
Surgical	25	7.8% (5.3–11.3)
Reason for current hospitalization
Pneumonia	57	17.8% (14.0–22.4)
Urinary tract infection	52	16.2% (12.6–20.7)
Stroke	31	9.7% (6.9–13.4)
Others	180	56.2% (50.8–61.6)

Variables	OR^* *OR – Odds Ratio;	95% CredI^† †95% CredI – 95% Credible interval;	Adjusted OR^‡ ‡Adjusted OR – Adjusted Odds Ratio.	95% CredI^† †95% CredI – 95% Credible interval;
Sex
Female	1.00	Ref.	1,00	Ref.
Male	0.98	0.89; 1.08	0.98	0.89; 1.08
Color
White	1.00	Ref.	1,00	Ref.
Non white	0.97	0.88; 1.08	0.97	0.88; 1.07
Age
60–70	1.00	Ref.	1,00	Ref.
70–80	1.01	0.90; 1.13	0.98	0.87; 1.11
80 or over	1.31	1.17; 1.46	1.22	1.08; 1.37
Schooling
Primary	1.00	Ref.	1,00	Ref.
Secondary	0.94	0.81; 1.10	1.03	0.89; 1.19
Higher Education	0.93	0.70; 1.22	0.94	0.72; 1.22
Systemic Arterial Hypertension
No	1.00	Ref.	1,00	Ref.
Yes	0.90	0.81; 0.99	0.95	0.87; 1.05
Diabetes mellitus
No	1.00	Ref.	1.00	Ref.
Yes	0.92	0.83; 1.01	1.01	0.92; 1.10
Chronic obstructive pulmonary disease
No	1.00	Ref.	1.00	Ref.
Yes	0.94	0.83; 1.06	0.95	0.85; 1.06
Chronic kidney disease
No	1.00	Ref.	1.00	Ref.
Yes	0.91	0.78; 1.06	0.92	0.81; 1.06
Epilepsy
No	1.00	Ref.	1.00	Ref.
Yes	1.35	1.06; 1.71	1.35	1.10; 1.66
Congestive heart failure
No	1.00	Ref.	1.00	Ref.
Yes	0.93	0.83; 1.05	0.97	0.87; 1.08
Dementia
No	1.00	Ref.	1.00	Ref.
Yes	1.68	1.52; 1.85	1.63	1.46; 1.81
Previous stroke
No	1.00	Ref.	1.00	Ref.
Yes	1.23	1.10; 1.37	1.14	1.03; 1.26

Variables	OR^* *OR – Odds Ratio;	95%CI^† †95%CI – 95% Confidence Interval;	Adjusted OR^‡ ‡Adjusted OR – Adjusted Odds Ratio;	95%CI^† †95%CI – 95% Confidence Interval;	p Value^§ §p-value – obtained via Wald test.
Intercept			0.12	0.02; 0.54	0.0092
Sodium
Normal	1.00	Ref.	1.00	Ref.
Below normal	0.93	0.83; 1.04	0.92	0.82; 1.03	0.2765
Potassium
Below normal	0.98	0.40; 2.21	0.90	0.33; 2.23	0.8258
Normal	1.00	Ref.	1.00	Ref.
Above normal	1.67	0.61; 4.18	1.69	0.54; 4.86	0.3471
Leukocytes
Below normal	1.06	0.05; 7.49	0.77	0.04; 6.04	0.8248
Normal	1.00	Ref.	1.00	Ref.
Above normal	1.50	0.82; 2.71	0.95	0.46; 1.93	0.8961
PCR
Normal	1.00	Ref.	1.00	Ref.
Above normal	1.17	1.02; 1.33	1.14	1.02; 1.30	0.0495

	TOTAL
	n = 320	95% CI^* *IC 95% CI – 95%Confidence Interval; (SD)^† †SD – Standard Deviation.
Sodium
Normal	205	64.1% (60.3–70.8)
Below normal	97	30.3% (26.2–36.4)
Above normal	10	3.1% (1.8–5.8)
Not collected	8
Acute kidney failure
Yes	90	28.1% (23.8–33.7)
No	226	70.6% (66.3–76.2)
Not collected	4
CRP
Normal	47	14.7% (13.0–21.8)
Above normal	230	71.9% (78.2–87.0)
Not collected	43
Hemoglobin
Normal	82	25.6% (21.6–31.3)
Below normal	228	71.2% (67.7–77.5)
Above normal	3	0.9% (0.3–2.8)
Not collected	7
Potassium
Normal	245	76.6% (73.4–82.5)
Below normal	42	13.1% (10.1–17.6)
Above normal	26	8.1% (5.7–11.9)
Not collected	7
Leukocytes
Normal	198	61.9% (57.6–68.2)
Below normal	5	1.6% (0.7–3.7)
Above normal	111	34.7% (30.3–40.8)
Not collected	6
Polypharmacy
Normal	166	51.9% (46.4–57.3)
Polypharmacy	131	40.9% (35.7–46.4)
Hyper polypharmacy	23	7.2% (4.8–10.6)
Number of medicines for home use
Mean (SD)	4.57 (3.06)
Median [Min, Max]	4.00 [0. 16.0]

	Total
	(n = 320)	(%)
Arterial hypertension	228	71.2%
Diabetes mellitus	110	34.4%
Dementia	67	20.9%
Brain stroke	64	20%
Hypothyroidism	63	19.7%
Dyslipidemia	63	19.7%
Congestive heart failure	59	18.4%
COPD	51	15.9%
Ischemic heart disease	37	11.5%
Depression	35	10.1%
Chronic kidney disease	23	7.2%
Parkinson’s disease	13	4%
Epilepsy	12	3.7%

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: João Alberto Martins, Rodrigues Rua Coronel Amazonas Marcondes, 448, Cabral80035-230 – Curitiba, PR, Brazil, morgadinho70@hotmail.com