Short-term clinical outcomes in delirious older patients: a study at general medical wards in a university hospital in Thailand.

AIM: Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes--length of stay (LOS), in-hospital mortality and 3-month mortality--among delirious Thai older patients. METHODS: A prospective observational study was carried out in a university hospital in Thailand. All patients aged older than 70 years admitted to general medical wards were included. Delirium assessments were undertaken within the first 24 h of admission and serially until discharge. Subsequent assessments were carried out at 3 months after discharge. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Factors associated with mortality were determined by using logistic regression models. RESULTS: LOS was significantly longer in the delirium group (10 and 8 days, P = 0.001). Furthermore, the delirium group had higher in-hospital and 3-month mortality (P < 0.001). Factors significantly associated with in-hospital mortality in multivariate analysis were age more than 80 years (AOR 2.74, 95% CI 1.05-7.15), malignancy (AOR 3.11, 95% CI 1.16-8.33), severe illness (AOR 3.75, 95% CI 1.38-10.20) and delirium (AOR 7.34, 95% CI 1.51-35.69). Delirium remained a strong predictor for 3-month mortality in multivariate analysis with AOR of 3.33 (95% CI 1.45-7.62) CONCLUSIONS: Delirium was associated with prolonged hospital-stay and was the strongest predictor for mortality among older hospitalized patients. It requires serious attention from physicians, healthcare administrators and policy makers to implement an appropriate management plan for this high-burden issue.

Prevalence and incidence of delirium in Thai older patients: a study at general medical wards in Siriraj Hospital.

BACKGROUND: Delirium, an acute decline in attention and cognition, is found to be a common life-threatening clinical syndrome among hospitalized older patients. However, there has been no study to date regarding prevalence and incidence of delirium in Thai older patients. OBJECTIVE: The authors aimed to determine prevalence and incidence of delirium in older patients admitted to general medical wards in a university hospital in Thailand. MATERIAL AND METHOD: A prospective observational study was conducted in Siriraj Hospital. All patients aged 70 years or older admitted to general medical wards during study period were included. Delirium assessments were undertaken initially within the first 24 hours of admission and serially every 48 hours until patients developed delirium or were discharged. Delirium was diagnosed by experienced geriatricians based on the DSM-IV criteria. Prevalence was based on delirium identified at the first assessment, whereas incidence was defined based on cases developed during hospitalization. RESULTS: Two hundred and twenty five patients were enrolled. The prevalence of delirium was 40.4%, while the incidence of delirium was 8.4%. Therefore, the total occurrence rate of delirium was remarkably high (48.9%). Occurrence rate of delirium significantly increased with age (p = 0.003) and illness severity (p < 0.001). Number of impaired activities of daily living was also associated with occurrence rate of delirium in older patients. CONCLUSION: In conclusion, the prevalence of delirium among older patients admitted to general medical wards in the present study were alarmingly high. Meanwhile, the incidence of delirium was comparable to other studies. Obviously, it requires serious attention from physicians, nurses and hospital administrators. These findings may reflect the importance of delirium detection for proper management. To lower morbidity and mortality in older patients, effective preventive strategies of delirium should be implemented promptly during hospital admission.

Risk factors for developing delirium in older patients admitted to general medical wards.

BACKGROUND: Delirium in older patients is common and leads to poor clinical outcomes. It is, however, preventable if its risk factors are identified and modified accordingly. OBJECTIVE: To determine risk factors associated with delirium in hospitalized older patients admitted to general medical wards at Siriraj Hospital. MATERIAL AND METHOD: A prospective observational study was conducted at general medical wards, Siriraj Hospital. All consecutive patients aged 70 years or older admitted during study period were assessed and followed until discharge. A diagnosis of delirium was made if patients developed symptoms which fulfilled DSM IV criteria. Information regarding demographic data, co-morbid illnesses, preexisting cognitive status and functional status was collected at admission. Factorf associated with delirium were analyzed using logistic regression models. RESULTS: Risk factors associated with developing delirium identified from univariate analysis were female gender, age more than 80 years-old, having 4 or more co-morbidities, azothemia, hyponatremia, presence of infection, severe illness, preexisting dementia, depression, and impaired basic activities of daily living. After adjusted in multivariate analysis; factors those remained statistically significant were preexisting dementia (OR = 5.52, 95% CI = 2.51-12.14), severe illness (OR = 5.18, 95% CI = 2.10-12.76) presence of infection (OR = 2.54, 95% CI = 1.15-5.61) and azothemia (OR = 2.55, 95% CI = 1.205.40). CONCLUSION: Pre-existing dementia and illness severity were strongly associated with developing delirium in older patients in the present study, which is concordant with previous studies. Other factors such as presence of infection and azothemia are modifiable factors that could potentially be important targets, along with other factors identified in the present study, for implementing intervention in order to prevent delirium in this population.