42 Resolution of delirium upon discharge & mortality rates among frail older persons attending an Emergency Department frailty service

Abstract

Abstract Background Delirium is an acute confusional state, frequently associated with older hospitalised patients and has been found to be related to several adverse outcomes including longer length of stay and mortality. Better baseline cognition has been linked with a lower risk of delirium however those with high baseline cognition may experience greater cognitive decline post delirium. Methods We undertook a retrospective study of 92 patients who attended the Frailty service in the Emergency Department between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and collected additional data collected to define baseline cognitive status, delirium resolution, and length of stay and discharge disposition. Results Delirium prevalence in this cohort was estimated at 22%. Overall delirium had resolved for our patients at discharge in 56% of cases. In the cognitively intact at baseline group (29%) delirium had resolved at discharge in 33% of cases only. For patients with baseline cognitive impairment (71%) delirium had resolved in 50% of cases. The mortality rate for patients with delirium was 14% with average CFS of 6. All patients who died had cognitive impairment at baseline. The mortality rate for patients without delirium was 1.4%. Length of stay ranged from 0 to 80 days. Length of stay for patients with delirium & baseline cognitively intact was 39 days. Length of stay for patients with delirium and baseline cognitively impaired was 8 days. Conclusion Two thirds of patients who were cognitively intact at baseline experienced longer length of stays & non resolution of delirium at discharge. There may be a need for dedicated follow up of these patients post-acute discharge. There was a higher mortality rate for patients with delirium and baseline cognitive impairment. Future studies may address illness acuity, delirium severity and duration & emergency department length of stay as influencers on mortality rate.