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Delirium in elderly patients is associated with an increased risk of dementia, death and institutionalization, according to a review and analysis of previous research [JAMA, 304 (4): 443-451].
Delirium is a syndrome of acutely altered mental status characterized by inattention and a fluctuating course. With occurrence rates of up to half of older patients post-operatively and even higher in elderly patients admitted to intensive care units, it is the most common complication in hospitalized older people. Evidence suggests an association with long-term poor outcome, but delirium often occurs in individuals with more severe underlying disease.
Joost Witlox, MSc, and colleagues at Medical Center Alkmaar, in the Netherlands, analyzed previous studies to assess the association between delirium and long-term poor outcomes in elderly patients while controlling for other important factors. Delirium was found to be associated with an increased risk of death compared with controls.
"Moreover, patients who had experienced delirium were at increased risk of institutionalization and dementia," the researchers stated. "These results provide evidence that delirium in elderly patients is associated with an increased risk of death, institutionalization and dementia independent of age, sex, illness co-morbidity or severity, and presence of dementia at baseline. This association persists when excluding studies that included in-hospital deaths and patients residing in an institution at baseline."
The results of this meta-analysis can be instrumental in patient care. The low rate of survival and high rates of institutionalization and dementia indicate that older people who experience delirium should be considered an especially vulnerable population.
"Future studies will have to establish what exact mechanisms are responsible for the long-term poor outcomes after delirium and whether clinical characteristics of delirium itself differentially influence prognosis," they said. "Moreover, clinical trials are needed to investigate whether the long-term sequelae associated with delirium can be averted."
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