Abstract | OBJECTIVES: (1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. DESIGN: Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. SETTING: Large academic hospital. PARTICIPANTS: Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only. MEASUREMENTS: RESULTS: Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs 16%, P < .001), HACs (37% vs 12%, P < .001), other noxious insults (63% vs 49%, P = .03), and 90-day mortality (24% vs 6%, P < .001). The inverse probability weighted hazard of death due to delirium was 4.2 (95% CI = 2.8-6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation. CONCLUSION: Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults.
|
Authors | Kumar Dharmarajan, Sunil Swami, Ray Y Gou, Richard N Jones, Sharon K Inouye |
Journal | Journal of the American Geriatrics Society
(J Am Geriatr Soc)
Vol. 65
Issue 5
Pg. 1026-1033
(May 2017)
ISSN: 1532-5415 [Electronic] United States |
PMID | 28039852
(Publication Type: Journal Article, Randomized Controlled Trial)
|
Copyright | © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society. |
Topics |
- Aged
- Aged, 80 and over
- Delirium
(etiology, mortality, prevention & control)
- Female
- Geriatric Assessment
- Hospitalization
- Humans
- Iatrogenic Disease
- Male
- Mortality
- Restraint, Physical
(methods)
|