Impact of delirium on short-term outcomes in hip fracture patients under a program of approach to delirium.

Rafael Bielza,Israel J. Thuissard,Eva Fernández de la Puente,Jorge Sanjurjo,Cristina Andreu,Jorge Gómez Cerezo,Francisco Zambrana

doi:10.1111/ggi.13838

Abstract

We aimed to investigate the impact of delirium on short-term outcomes in hip fracture patients. Special attention was given to patients with delirium and dementia. A prospective observational cohort study was carried out in hip fracture patients aged ≥70 years who were admitted to a hospital unit where a multicomponents approach to delirium is established for all patients. Our population was split into delirium (n = 212) and non-delirium cohort (n = 171) according to the Confusion Assessment Method. Patients with a previous diagnosis of dementia in an outpatient appointment were also assessed within the delirium cohort. The utility of the rehabilitation was measured with the Absolute Functional Gain index. A total of 383 patients were entered into the study. The median age was 86 years, and most patients were women (78.8%). Delirium patients were older, presented a lower previous Barthel Index (BI), had higher rates of dementia and came more frequently from nursing homes. Comparative analysis did not show differences in mortality, complications, length of stay or walking ability between the cohorts. However, lower BI on discharge, lower Absolute Functional Gain and the presence of nosocomial infections were found more frequently in the delirium cohort. In multivariate analysis, only the BI on discharge (P = 0.010) was lower in delirium patients. Within the delirium cohort, those suffering from dementia had worse BI on discharge (P = 0.017) and lower Absolute Functional Gain (P = 0.019). Delirium was not associated with mortality, walking ability, length of stay and clinical complications in hip fracture patients. BI on discharge was the only short-term outcome affected. In the delirium cohort, those suffering from dementia showed worse rehabilitation results. Geriatr Gerontol Int 2020; 20: 130-137.

Highlights

Delirium affects 28–61% of hip fracture (HF) patients, and is associated with poor outcomes in the acute phase, such as longer length of stay, greater rate of institutional placement, worse functional recovery and higher costs.[1]
Delirium was not associated with mortality, walking ability, length of stay and clinical complications in hip fracture patients
Barthel index (BI) on discharge was the only short-term outcome affected. Those suffering from dementia showed worse rehabilitation results

Summary

Introduction

Delirium affects 28–61% of hip fracture (HF) patients, and is associated with poor outcomes in the acute phase, such as longer length of stay, greater rate of institutional placement, worse functional recovery and higher costs.[1] This syndrome is characterized by a change in mental status with attention and awareness deficits, loss of cognitive and perceptive functions, and alterations in the sleep cycle.[2] The most widely used instrument for identification of delirium is the Confusion Assessment Method (CAM) 130 |. Given the consequences of delirium and its high prevalence in HF patients, the identification of people at risk of developing delirium, and the implementation of strategies to reduce and prevent its morbidity are highly desirable.[3] Comprehensive geriatric care reduces the incidence of perioperative delirium, but there is limited evidence showing whether these approaches have an impact on short-term outcomes, such as clinical complications, length of stay or functional recovery.[1,4,5].

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