Delirium symptoms and low dietary intake in older inpatients are independent predictors of institutionalization: a 1-year prospective population-based study.
Open Access
- 1 April 2004
- journal article
- research article
- Published by Oxford University Press (OUP) in The Journals of Gerontology: Series A
- Vol. 59 (4), M350-M354
- https://doi.org/10.1093/gerona/59.4.m350
Abstract
Objective. To assess the effects of delirium on the institutionalization rate, taking into account geriatric syndromes and nutritional status. Methods. This population-based study took place in an acute care unit and included participants older than 75 years, arriving from home and later discharged. Confusion Assessment Method (CAM) symptoms were recorded by the nurses within 24 hours after admission and every 3 days. Delirium was defined using the CAM algorithm, and subsyndromal delirium responded to symptoms not fulfilling the CAM algorithm. These delirium categories were either present at admission (prevalent) or occurred during the hospital stay (incident). Participants were classified as having a low dietary intake when energy intake was at any time lower than 600 kcal/d. Age, sex, known cognitive impairment, weight, functional dependency, and laboratory testing as well as diagnoses were also recorded. Step-by-step backward logistic regression was used to identify predictors of institutionalization. Results. Among 427 patients, 310 (72.6%) were discharged and were compared with 117 (27.4%) participants admitted to an institution. Female sex (odds ratio [OR]: OR 2.15, 95% confidence interval [CI]: CI 1.22–3.78), prevalent delirium (OR 3.19, 95% CI 1.33–7.64), subsyndromal delirium (OR 2.72, 95% CI 1.48–5.01), incident subsyndromal delirium (OR 4.27, 95% CI 2.17–8.39), low dietary intake (OR 2.50, 95% CI 1.35–4.63), and a fall (OR 2.16, 95% CI 1.22–3.84) or a diagnosis of stroke (OR 2.03, 95% CI 1.04–3.94) were independent predictors of institutionalization. Conclusions. Symptoms of delirium and severe nutritional impairment led patients to geriatric institutions. Therefore, these institutions need to implement policies that address both of these issues.Keywords
This publication has 19 references indexed in Scilit:
- Do guidelines improve the process and outcomes of care in delirium?Age and Ageing, 2003
- Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patientsClinical Nutrition, 1999
- Predisposing and Precipitating Factors for Delirium in Hospitalized Older PatientsDementia and Geriatric Cognitive Disorders, 1999
- A Multicomponent Intervention to Prevent Delirium in Hospitalized Older PatientsThe New England Journal of Medicine, 1999
- Disposition after Acute Stroke: Who Is Not Sent Home from Hospital?Neuroepidemiology, 1998
- The Prognostic Significance of Delirium in Older Hospital PatientsJournal of the American Geriatrics Society, 1997
- Validation of a combined comorbidity indexJournal of Clinical Epidemiology, 1994
- Increasing the Recognition of Delirium in Elderly PatientsJournal of the American Geriatrics Society, 1994
- Prognosis after Hospital Discharge of Older Medical Patients with DeliriumJournal of the American Geriatrics Society, 1992
- DeliriumArchives of Internal Medicine, 1992