Objective: Delirium is a common neuropsychiatric syndrome in older patients admitted to hospital with serious impact on prolonged ward stay and mortality. The aim of the present investigation was to study the incidence, predisposing and precipitating factors, clinical profile, and outcome of delirium in older patients admitted to a department of general internal medicine.
Design: Prospective clinical assessment study.
Materials and Methods: 400 patients, 70 years and older consecutively admitted to 2 wards at the Department of General Internal Medicine at Sundsvall Hospital, Sweden. The patients were assessed using the Organic Brain Syndrome Scale (OBS Scale) and the Mini Mental State Examination (MMSE)at day 1, 3, and 7 after admission. Medical and social data were collected from the patients, their caregivers, and from medical records. Delirium was diagnosed according to DSM-IV criteria.
Results: Delirium on the first day of admission occurred in 125/400 (31.3%) of the patients and was associated with, old age, male sex, impaired vision and hearing, previous dementia diagnosis, previous stroke, epilepsy, glaucoma, previous registered delirium, treatment with antiepileptics, neuroleptics, and drugs with anticholinergic properties. Precipitating delirium symptoms and diagnoses were stroke, epilepsy and fever on day one (>=38°C). 30 patients (24.0%) had an hypoactive delirium, 27 (21.6%) had an hyperactive delirium, 19 (15.2%) had a mixed delirium but 49 were not possible to classify. 60 patients (48.0%) had a predominantly emotional delirium, 24 (19.2%) a psychotic delirium and 15 (12%) were judged to have a mixed emotional and psychotic delirium. 26 were not possible to classify in this perspective. It was possible to describe the diurnal variation in 73/125 of the delirious patients. 32 patients had afternoon-evening-night-time delirium and 30 patients had a fluctuating delirium throughout the day and night. 8 patients were delirious only in the morning. In 44 of the delirious patients, delirium was detected and diagnosed only due to the repeated cognitive assessments and the diurnal variation was not possible to decide. In another 8 patients, there were only documented fluctuations between days. Patient who were delirious had significantly longer hospital stay, 15.4±14.2 compared to 9.5±7.8 for those who were not delirious, p<0.001. Mortality during hospital stay was significantly higher among those with delirium (11/125 (8.8%) vs 5/275 (1.8%); p=0.001).
Conclusion: Since predisposing and precipitating factors for delirium usually are easily identified among older patients admitted to general internal medicine and that delirium seem to be one of the most important independent prognostic factors more attention have to be paid to prevention and treatment.
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