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DELIRIUM DOUBLES THE DEATH RATE FOR PATIENTS >65

Clinical Bottom Line:
When patients >65 are admitted with delirium, in comparison to the non-delirious their risk of death is doubled (to 11% in hospital and 38% within a year), their risk of re-admission increases by half (to 34% in 6 months and 55% within a year) and their risk of winding up in residential care is tripled (to 31% by 6 months and 35% within a year).

Reference: George J, Bleasdale S, Singleton SJ: Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age & Ageing 1997;26:423-7. Appraised by: Sackett at the Centre; 02 March 1998

Three-part Question: Among elderly patients admitted to hospital, does delirium increase their likelihood of mortality and institutionalisation?

Search Terms: encountered in EBM picking

The Study:
171 patients >65 y/o (mean 81) admitted to a DGH (376 beds; catchment of 190K) but not terminally ill.
Prognostic Factor: Delirium (DSM III), compared with an age, sex, diagnosis-matched group of 95 patients who were free of delirium.
The Outcome: Mortality and institutionalisation.
Well-defined sample at uniform (early) stage of illness..?, yes
Follow-up long enough..?yes
Follow-up complete..?can't tell
Blind and objective outcome criteria..?can't tell
Adjustment for other prognostic factors..?no
Validation in an independent "test-set" of patients..?, no

The Evidence:

Prognostic Factor

Outcome

Time

Measure

Confidence Interval

Independent..?

Delirium

death

in hospital

11%

+/- 5%

no

6 and 12 months

31%, 38%

    

Free of delirium (same age, sex, and diagnosis)

death

in hospital

6 and 12 mos

6%

13%, 21%

+/- 5%

no

Delirium

re-hospitalisation

by 6 & 12 mos

34%, 55%

  

no

residential care

by 6 & 12 mos

31%, 35%

    

Free of delirium

re-hospitalisation

by 6 & 12 mos

21%, 38%

  

no

residential care

by 6 & 12 mos

11%, 12%

    

Comments:

  1. DSM-III diagnosis of delirium requires clouding of consciousness with reduced capacity to shift, focus, and sustain attention to environmental stimuli; plus at least 2 of perceptual misinterpretation/ illusion/ hallucination OR incoherent speech at times OR night-time insomnia or daytime drowsiness OR increased/ decreased psychmotor activity; disorientation and memory impairment; onset within hours or days with fluctuation; evidence of a specific organic factor from the exam or lab tests.

  2. 34% of delirious patients had chest or urinary (or other) infection; 11% had stroke; 11% were drug related; 5% had MI, 5% had hip fracture.

Expiry date: 1 March 1999


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