Prognosis after Hospital Discharge of Older Medical Patients with Delirium

Abstract

Objective: To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium. Design: Descriptive cohort study. Setting: General medical wards of a teaching hospital. Patients: Two hundred twenty‐nine consecutive patients aged 70 years or older who had been community‐dwelling prior to admission. Fifty patients met criteria for delirium (cases); these were compared to patients without delirium (controls). Two‐hundred twenty‐three patients survived hospitalization (46 cases, 177 controls) Of these, 92% were followed ≥2 years. Main Outcome Measures: Vital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or caregivers 2 years after discharge. Independent community living was defined as survivorship outside of an institution and without dependence in any of four basic ADL (bathing, dressing, transfers, eating). Results: Two‐year mortality in the entire population was 39% for cases and 23% for controls (relative risk 1.82, 95% confidence interval 1.04–3.19). Delirium identified those patients at risk for loss of independent community living, even after adjustment for potential confounding variables (adjusted odds ratio 2.56, 95% confidence interval 1.10–5.91). Follow‐up cognitive testing in a subset of patients with high baseline performance revealed a greater decline in performance among cases of delirium than controls ( P = 0.023). Conclusions: Delirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.