Persistent Delirium Predicts Greater Mortality

Authors

  • Dan K. Kiely MPH, MA,

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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  • Edward R. Marcantonio MD, SM,

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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  • Sharon K. Inouye MD, MPH,

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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  • Michele L. Shaffer PhD,

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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  • Margaret A. Bergmann MS, GNP,

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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  • Frances M. Yang PhD,

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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  • Michael A. Fearing PhD,

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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  • Richard N. Jones ScD

    1. From the *Institute for Aging Research, Hebrew SeniorLife, Boston, MassachusettsDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartment of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts§Division of Biostatistics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and Department of Psychiatry, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts.
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Address correspondence to Dan K. Kiely, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131-1097. E-mail: kiely@hrca.harvard.edu

Abstract

OBJECTIVES: To examine the association between persistent delirium and 1-year mortality in newly admitted post-acute care (PAC) facility patients with delirium who were followed regardless of residence.

DESIGN: Observational cohort study.

SETTING: Eight greater-Boston skilled nursing facilities specializing in PAC.

PARTICIPANTS: Four hundred twelve PAC patients with delirium at admission after an acute hospitalization.

MEASUREMENTS: Assessments were done at baseline and four follow-up times: 2, 4, 12, and 26 weeks. Delirium, defined using the Confusion Assessment Method, was assessed, as were factors used as covariates in analyses: age, sex, comorbidity, functional status, and dementia. The outcome was 1-year mortality determined according to the National Death Index and corroborated using medical record and proxy telephone interview.

RESULTS: Nearly one-third of subjects remained delirious at 6 months. Cumulative 1-year mortality was 39%. Independent of age, sex, comorbidity, functional status, and dementia, subjects with persistent delirium were 2.9 (95% confidence interval=1.9–4.4) times as likely to die during the 1-year follow-up as subjects whose delirium resolved. This association remained strong and significant in groups with and without dementia. Additionally, when delirium resolved, the risk of death diminished thereafter.

CONCLUSION: In patients who were delirious at the time of PAC admission, persistent delirium was a significant independent predictor of 1-year mortality.

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