Objective: To investigate the association of an episode of delirium with the outcome in terms of cognitive decline, dementia, functional disability, and death.
Design: Prospective observational study of a sample of elderly hip surgery patients, who are known as a high-risk group for the development of delirium.
Materials and Methods: A sample of consecutive patients aged between 60 and 97 years (n=200) underwent preoperative and daily postoperative assessment of mental state during their hospital stay. A diagnosis of delirium was based on the criteria of the Confusion Assessment Method (CAM). The patients were followed for an average of 38 months after discharge, when survival status, nursing home placement, and ability to perform activities of daily living were determined. Among the surviving patients, cognitive functioning was measured with the MMSE. Those suffering from a confusional state during hospital stay were compared to those who were free from delirious symptoms. Statistical analyses adjusting for the effect of confounding variables were carried out using multiple logistic regression models and Coxx proportional hazards regression.
Results: Postoperative delirium developed in 41 patients (20.5%). The most important risk factors for delirium were old age and preoperative cognitive performance. Information on long-term outcome could be obtained for 99% of the sample. 16% died after discharge, 17% suffered from severe incident disability, and 13% developed a dementing disorder or showed a marked cognitive decline. After adjustment for age, sex, preoperative cognitive performance, and duration of follow-up delirium was not associated with survival rate (adjusted hazard ratio = 1.4; 95-%-CI 0.6-3.3), but increased the risk of severe disability (adjusted odds ratio = 6.3; 95-%-CI 1.8-21.6), and of incident cognitive impairment and dementia (adjusted odds ratio = 18.3; 95-%-CI 3.3-102.2).
Conclusion: The study confirms a generally poor prognosis after delirium. Delirium indicates a high risk of cognitive decline and dementia. These findings suggest that delirium in old age represents an early risk marker of incipient dementia.
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