Underestimated factors may also precipitate delirium and can lead to the misinterpretation of frailty in these patients.

Abstract

Dear editor We have read the article entitled “Association between frailty and delirium in older adult patients discharged from hospital” by Verloo et al1 with great interest. In their study, the authors observed that frailty is strongly associated with delirium in older patients at hospital discharge. Consequently, they concluded that assessing frailty gives health care professionals the opportunity to improve the effectiveness of primary prevention strategies for delirium, by promptly ascertaining which discharged older adults are at a higher risk of presenting with that syndrome. We would like to give comments on a few points of this study. In the methodology section, the authors stated that frailty was assessed using the Edmonton Frailty Scale, which includes nine domains as two of cognitive impairment and functional dependency by using the Mini-Mental State Examination (MMSE) and Lawton Index of instrumental activities of daily life, respectively, at hospital discharge. According to these MMSE scores, patients have been divided into categories with regard to cognitive impairment. We would like to ask the authors about how they distinguished the impact of delirium on MMSE scores; because delirium itself may lead to lower MMSE scores independent of basal cognitive state. And this may cause misinterpretation of the patients as frail. Also, no information was given if the patients have had dementia diagnosis, which is known as one of the important risk factors for delirium.2 Regarding the assessment of functional dependency, the authors stated that a score of <16 indicates that the patient is independent, which is not in accordance with the original Lawton Index of instrumental activities of daily life article.3 Can the authors clarify this point? Another point is that, the authors compared only a number of daily medications between delirium and nondelirium groups both of which used a similar number of medications. However, certain medications may play a role in the risk of delirium. Anticholinergic agents, fluoroquinolones, and benzodiazepines are among those reported to precipitate delirium. We suggest that the data regarding the use of such medications may provide relevant information.4 Regarding the number of delirious patients, there is conflicting data in this study. It was stated as n=22 in the abstract, n=94 in Table 2, and n=20 in the result’s section. Thus, clarification of this confusion would be beneficial.