Abstract
ObjectivesTo investigate the association between delirium motor subtypes and hospital mortality and 12-month mortality in hospitalized older adults.DesignProspective cohort study conducted from 2009 to 2015.SettingGeriatric ward of a university hospital in Sao Paulo, Brazil.ParticipantsWe included 1,409 consecutive admissions of acutely ill patients aged 60 years and over. We excluded admissions for end-of-life care, with missing data on the main variables, length of stay shorter than 48 hours, or when consent to participate was not given.Main outcomes and measuresDelirium was detected using the Confusion Assessment Method and categorized in hypoactive, hyperactive, or mixed delirium. Primary outcomes were time to death in the hospital, and time to death in 12 months (for the discharged sample). Comprehensive geriatric assessment was performed at admission and included socio-demographic, clinical, functional, cognitive, and laboratory variables. Further clinical data were documented upon death or discharge. Multivariate analyses used Cox proportional hazards models adjusted for possible confounders.ResultsWe included 1,409 admissions, with a mean age of 80 years. The proportion of in-hospital deaths was 19%, with a cumulative mortality of 38% in 12 months. Delirium occurred in 47% of the admissions. Hypoactive delirium was the predominant motor subtype (53%), followed by mixed delirium (30%) and hyperactive delirium (17%). Hospital mortality rates were respectively 33%, 34% and 15%. We verified that hypoactive and mixed delirium were independently associated with hospital mortality, with respective hazard ratios of 2.43 (95%CI = 1.64–3.59) and 2.31 (95%CI = 1.53–3.50). Delirium motor subtypes were not independently predictive of 12-month mortality.ConclusionsOne in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital. Clinicians should be aware that hypoactive symptoms of delirium, whether shown exclusively or in alternation with hyperactive symptoms, are indicative of a worse prognosis in this population.
Highlights
Delirium affects up to 50% of hospitalized older adults
One in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital
Clinicians should be aware that hypoactive symptoms of delirium, whether shown exclusively or in alternation with hyperactive symptoms, are indicative of a worse prognosis in this population
Summary
Delirium affects up to 50% of hospitalized older adults. It is associated with several unfavorable outcomes and it is estimated that more than US$160 billion are annually spent on the disorder in the United States [1,2,3]. It typically manifests with either of two patterns of psychomotor activity: hypoactive or hyperactive [4]. Hypoactive delirium is characterized by stupor, psychomotor lentification and lethargy, and is the most frequent pattern in older adults [5]. Cases in which an alternance of the two patterns is observed are common and classified as mixed delirium [6]
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