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In-hospital delirium linked with worse long-term outcomes in elderly

Clinical Question:
Is delirium in hospitalized elderly patients associated with a poor long-term prognosis?

Bottom Line:
In elderly patients, delirium is independently associated with an increased risk of postdischarge death, institutionalization, and dementia. Since previous studies have not found a reduction in mortality or institutionalization rates when delirium is treated once it occurs, clinicians should focus on preventing delirium in the first place to avoid these poor long-term outcomes. (LOE = 2a)

Reference:
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia. JAMA 2010;304(4):443-451.  [PMID:20664045]

Study Design:
Meta-analysis (other)

Funding:
Unknown/not stated

Allocation:
Uncertain

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
These authors searched MEDLINE, EMBASE, and other databases, and reviewed bibliographies of retrieved articles, to find observational studies that examined the association between delirium and long-term outcomes, including mortality, institutionalization, and dementia. Eligible studies had a mean or median study population age of at least 65 years, occurred in the hospital or postacute care setting, and had a follow-up assessment at 3 months or more. Studies with homogeneous populations of terminally ill patients or patients with central nervous system diseases were excluded. Two or more authors independently assessed study eligibility and data extraction. Only high-quality studies, assessed with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies, were included in the final analyses. The included studies also had a prospective design and used a validated method to assess delirium. The initial search yielded 2939 articles and 42 were included in the meta-analysis. Primary analyses were performed using those studies that adjusted for age, sex, comorbidities, illness severity, and baseline dementia. After an average follow-up of almost 2 years in 7 studies, delirium was associated with an increased risk of death (38% vs 27.5% in control groups; hazard ratio = 1.95; 95% CI, 1.51-2.52). In addition, delirium was associated with greater risks of institutionalization at a mean follow-up of 15 months (33.4% vs 10.7%; odds ratio [OR] = 2.41; 1.77-3.29) and dementia at a mean follow-up of 4 years (62.5% vs 8.1%; OR = 12.52; 1.86-84.21). No publication biases were detected.

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