Abstract
BackgroundDelirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes.MethodsWe conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions.ResultsThe point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21).ConclusionsDelirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.
Highlights
Delirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital
Possible delirium was coded as no delirium, and probable dementia was coded as dementia
Possible delirium was associated with increased length of stay when compared to patients without delirium (+ 2.21 days, CI 0.27– 4.52; p = 0.038); 4 A’s Test (4AT)-positive status with no evidence of delirium was not associated with increased length of stay (Table 2; Additional file 2: Tables S7-S8)
Summary
Delirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Psychomotor subtypes are hyperactive, characterised by motor agitation, perceptual differences, and delusions, and hypoactive, featuring predominantly motor retardation and thought process abnormality; or mixed [3] It is very common, but prevalence differs across populations: 10–31% for most acute settings outside critical care [4]. Delirium is consistently associated with increased mortality, accounting for age, co-morbidity, and acute illness [6]. It is associated with increased length of hospital stay, new institutionalisation, and distress to patients and families [4, 7]. Few studies have assessed the relationship between delirium and frailty [11,12,13,14]
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