Abstract
BackgroundRoom transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence. We used a case–control study to determine if the number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients, controlling for baseline risk factors.MethodsWe included patients 70 years of age or older who were admitted to the internal medicine or geriatric medicine services at St. Michael’s Hospital between October 2009 and September 2010 for more than 24 h. The cases consisted of patients who developed delirium during the first week of hospital stay. The controls consisted of patients who did not develop delirium during the first week of hospital stay. Patients with evidence of delirium at admission were excluded from the analysis. A multivariable logistic regression model was used to determine the relationship between room transfers and delirium development within the first week of hospital stay.Results994 patients were included in the study, of which 126 developed delirium during the first week of hospital stay. Using a multivariable logistic regression model which controlled for age, gender, cognitive impairment, vision impairment, dehydration, and severe illness, room transfers per patient days were associated with delirium incidence (OR: 9.69, 95 % CI (6.20 to15.16), P < 0.0001).ConclusionsAn increased number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients. This is an exploratory analysis and needs confirmation with larger studies.
Highlights
Room transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence
Patients who developed incident delirium were slightly less likely to have transient ischemic attack or stroke listed as their admission diagnosis
Primary outcome Using a multivariable logistic regression model which controlled for age, gender, cognitive impairment, vision impairment, dehydration, and severe illness, room transfers per patient days was associated with increased
Summary
Room transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence. We used a case–control study to determine if the number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients, controlling for baseline risk factors. It is estimated that 14 % to 24 % of older patients are delirious upon admission to acute care hospitals, and another 6 % to 56 % of patients develop delirium while in hospital [2]. Delirium development in older patients is associated with increased morbidity and mortality, and greater healthcare costs [3,4,5,6,7,8,9,10]. Predisposing factors for delirium include older age, dementia, coexisting medical conditions, functional dependence, vision and hearing impairment, trauma, volume depletion, alcohol abuse, neurologic disease, and depression [2,3,4, 11]. Delirium precipitants in hospital include polypharmacy, psychotropic drugs, infections, sleep disruption, uncontrolled pain, metabolic derangements, use of urinary catheters and mechanical restraints, malnutrition, surgery, prolonged anaesthesia, and intensive care unit admission [2,3,4, 12]
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