Proportion, Predictors and Outcomes of Delirium at a Tertiary care Hospital in Karachi, Pakistan

Abstract

Delirium is seen in about one third of all sick elderly patients. As elderly inpatient admissions increase in our setting, it becomes important to understand the risk factors and predictors of delirium to better manage and prevent this disorder. A retrospective analysis of medical records of all patients 65 years and older admitted in 2009 at the Aga Khan University Hospital, Karachi was performed. A pretested questionnaire was designed to obtain information on patient demographics, diagnoses, medication usage, hospital course, and complications. All patients that had a diagnosis or sub-diagnosis of delirium were reviewed for associated factors, causes, and outcomes. Data were compared between patients with and without delirium for associated factors, and outcomes. Multivariable logistic regression was performed and crude and adjusted odds ratio with 95 % confidence interval was calculated. A total of 464 charts were reviewed and 22 % were found to have delirium. Infection was the most common cause of delirium. Increasing age (AOR 1.9), prior neurological disorder (AOR 2.2), pneumonia (AOR 3.3) and urinary tract infection (AOR 3.1), psychoactive drug use (AOR 2.1), and poor functionality (AOR 5.75) were strongly associated with an increased risk of delirium. Delirium was associated with higher length of stay, and medical complication rate and increased mortality. This was a baseline study that confirmed the commonly known risk factors for delirium. Of most concern was poor functional status and psychoactive drug use in the overall patient sample. It highlighted the need for using appropriate and timely diagnostic tests to identify delirium in our elderly inpatients.