Delirium and mortality, institutionalization, and dementia

January 01, 0001

Delirium and mortality, institutionalization, and dementia

Delirium has been linked with long-term poor outcome but this link in confounded by the high rate of comorbidites in patients who suffer from delirium. These Dutch researchers examined the link between delirium in elderly patients and long mortality, institutionalization, or dementia, while controlling for confounders. They performed a systematic search of observational studies of elderly patients with delirium published between 1981 and 2010 using MEDLINE, EMBASE, PsycINFO, and CINAHL.

The authors report: "The primary analyses included only high-quality studies with statistical control for age, sex, comorbid illness or illness severity, and baseline dementia. Pooled-effect estimates were calculated with random-effects models. The primary analysis with adjusted hazard ratios (HRs) showed that delirium is associated with an increased risk of death compared with controls after an average follow-up of 22.7 months (7 studies, 271/714 patients {38.0%} with delirium, 616/2243 controls {27.5%}, HR 1.95). Moreover, patients who had experienced delirium were also at increased risk of institutionalization (7 studies, average follow-up 14.6 months, 176/527 patients {33.4%} with delirium and 219/2052 controls {10.7%}, odds ratio {OR} 2.41) and dementia (2 studies, average follow-up 4.1 years, 35/56 patients {62.5%} with delirium and 15/185 controls {8.1%}, OR 12.52). The sensitivity, trim-and-fill, and secondary analyses with unadjusted high-quality risk estimates stratified according to the study characteristics confirmed the robustness of these results."

The authors concluded: "This meta-analysis provides evidence that delirium in elderly patients is associated with poor outcome independent of important confounders, such as age, sex, comorbid illness or illness severity, and baseline dementia."

This study provides clearer evidence of the link between delirium and long term poor outcomes in elderly patients.

For the full abstract, click here.

JAMA 304(4):443-451, 28 July 2010
© 2010 American Medical Association
Delirium in Elderly Patients and the Risk of Postdischarge Mortality, Institutionalization, and Dementia: A Meta-analysis. Joost Witlox, Lisa S. M. Eurelings, Jos F. M. de Jonghe, Kees J. Kalisvaart, Piet Eikelenboom, Willem A. van Gool.

Category: N. Neurological. Keywords: delirium, elderly, mortality, dementia, institutionalization, systematic review with meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 17 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.