Older Adults Discharged from the Hospital with Delirium: 1-Year Outcomes.

Autor: McAvay, Gail J., Van Ness, Peter H., Bogardus Jr., Sidney T., Ying Zhang, Leslie, Douglas L., Leo-Summers, Linda S., Inouye, Sharon K.
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Zdroj: Journal of the American Geriatrics Society; Aug2006, Vol. 54 Issue 8, p1245-1250, 6p, 3 Charts
Abstrakt: OBJECTIVES: To compare 1-year institutionalization and mortality rates of patients who were delirious at discharge, patients whose delirium resolved by discharge, and patients who were never delirious in the hospital. DESIGN: Secondary analysis of prospective cohort data from the Delirium Prevention Trial. SETTING: General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998, with follow-up interviews completed in 2000. PARTICIPANTS: Four hundred thirty-three patients aged 70 and older who were not delirious at admission. MEASUREMENTS: Patients underwent daily assessments of delirium from admission to discharge using the Confusion Assessment Method. Nursing home placement and mortality were determined at 1-year follow up. RESULTS: Of the 433 study patients, 24 (5.5%) had delirium at discharge, 31 (7.2%) had delirium that resolved during hospitalization, and 378 (87.3%) were never delirious. After 1 year of follow-up, 20 of 24 (83.3%) patients discharged with delirium, 21 of 31 (67.7%) patients whose delirium resolved, and 157 of 378 (41.5%) patients who were never delirious were admitted to a nursing home or died. Compared with patients who were never delirious, patients with delirium at discharge had a multivariable adjusted hazard ratio (HR) of 2.64 (95% confidence interval (CI)=1.60–4.35) for nursing home placement or mortality, whereas resolved cases had a HR of 1.53 (95% CI=0.96–2.43). CONCLUSION: Delirium at discharge is associated with a high rate of nursing home placement and mortality over a 1-year follow-up period. Interventions to increase detection of delirium and improvements in transitional care may help reduce these negative outcomes. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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