Friday, August 4, 2006
The current Journal of the American Geriatrics Society has prospective study on long-term outcomes for elderly patients with delirium during a hospitalization. It prospectively looked at ~430 elderly (70 years and older; mean age 80) patients admitted to a non-ICU medical service at a single hospital who were, at some point during the hospitalization, diagnosed with delirium. This study compares those who were never delirious with those who were discharged still delirious with those whose delirium had resolved. It presents 1 year follow up data and they are confirmatory of delirium being a poor pr ognostic marker: After one year 38% of those with delirium at discharged had died, compared with 26% with resolved delirium and 20% of those who were never delirious. The study's composite outcome of death or nursing home placement was 83% for those delirious at discharge, compared to 68% and 42%, respectively, of the other two groups. These trends were statistically significant when comparing the never delirious with the delirious at discharge group, although it's unclear to me whether they were significant comparing the resolved delirium with the never delirious group.
In a related article the same issue presents a prospective study of outcomes after delirium associated with a stroke . 1 year mortality was markedly worse in the delirious patients than those who did not develop delirium: 41% vs 17%. These two articles are further information of just how powerful a prognostic marker delirium is in these older populations. It should be part of our calculus of identifying older people in particular need of palliative & advanced-care focused assessments and interventions.
(The same issue also has an article comparing patterns of home health and hospice use by older adults with cancer with those without cancer.)