Delirium Predicts 12-Month Mortality

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Abstract
DELIRIUM is a frequent phenomenon among older hospitalized patients and has been found to be related to several adverse outcomes, including a longer mean length of hospital stay, poor functional status and need for institutional care, and mortality.1 With respect to mortality, the evidence is not consistent2; controlled studies have reported that delirium is associated with increased in-hospital mortality.2,3 However, Inouye et al4 controlled for age, sex, dementia, illness severity, and functional status and found no significant elevation in in-hospital or 3-month mortality. Several studies with up to 2 years of follow-up reported no significant increase in postdischarge mortality.3,5-7 A recent study with a median follow-up of 32.5 months reported a hazard ratio (HR) of 1.71 (95% confidence interval [CI], 1.02-2.87) after adjustment for comorbidity, dementia, frailty, age, sex, marital status, and institutional residence.8 Nevertheless, these studies have a number of methodologic limitations, including small sample sizes, often-limited follow-up, and inadequate control of confounding factors such as dementia, comorbidity, and severity of illness. Furthermore, it is not known whether survival depends on the severity of the delirium, or on whether the delirium is diagnosed at admission (prevalent delirium) or after admission (incident delirium). The former is related to factors preceding hospital admission, whereas the latter may be due to aspects of the care received in the hospital. Also, little is known about whether the adverse consequences of delirium are similar among demented and nondemented patients.