Introduction: Delirium is frequent in hospitalized older people, with
incidence rate up to 40% in acute care. Delirium is associated with
several adverse consequences, including increased mortality and
institutionalization. This study aims to investigate the prevalence,
incidence, and consequences of delirium in patients hospitalized in
an acute care unit for elderly (ACE unit).
Methods: Over a 3 months period, every patient (N = 93, mean age
84.1 ± 7.8 years, 66/93(71%) women) admitted to a 28-bed ACE unit
were systematically assessed for delirium. Trained nurses used the
Confusion Assessment Method (CAM) instrument to determine the
presence of delirium at admission and on each subsequent day over
patients' stay. Delirium prevalence rate was defined as the proportion of
patients with a positive CAM within 24 hours of admission to the ACE
unit. Delirium incidence rate was defined as the proportion of patients
with a negative CAM at admission whose CAM became positive at least
once during their stay. This evaluation was part of a functional
assessment, including Basic Activities of Daily Life (Katz BADL, from
0 to 6, higher score indicating better function). Delirium prevention
interventions and specific treatment was provided if needed.
Results: Overall,25/93(27%)patients had delirium during their stay.
Prevalence of delirium at admission was 10/93 (11%), with an incidence
of 15/83(18%). Compared with non-delirious patients, those with
delirium were more frequently men (10/25(40%) vs 17/68(25%),
p <.001) and had reduced functional status at admission(BADL 2.0 ±
1.9 vs 3.6 ± 2.1, p = .004). They tended to be older (86.0 ± 6.7 vs 83.3 ±
8.1 years, p = .110). At discharge, delirium was associated with reduced
functional status (BADL 2.0 ± 2.1 vs 4.3 ± 1.9, p <.001), lower rate of
home discharge (6/20(30%) vs 28/65 (43%), p = .009) and increased
mortality (5/25 (20%) vs 3/68 (5%), p <.001). On average, patients with
delirium stayed 5.7 days longer (17.0 ± 9.8 vs 11.31 ± 6.3, p = .011).
Conclusion: Delirium occurred in almost a third of these older patients,
even though its incidence was relatively low in this frail population.
Despite specific management, delirium remained associated with
higher risk for adverse outcomes at discharge. These results suggest
that early preventive interventions, implemented as soon as possible
after hospital admission, might be needed in similar population to
achieve better outcomes. Effectiveness of such interventions will be
evaluated in future studies.