Why Care About Delirium?
Delirium is common
Prevalent delirium in older ED patients: 8% to 17% overall; 40% of nursing home residents
Overall occurrence of delirium (prevalent+incident) in older patients admitted to medical or geriatric wards: 29% to 64%
Delirium is frequently missed
ED physicians miss delirium in 65% to 85% of cases.
- If admitted, often missed by inpatient team
- Up to 35% of patients with delirium are discharged
Delirium is associated with poor outcomes
Adverse outcomes associated with delirium.
- Increased rate of inpatient falls
- Greater health care utilization and expenditures
- Longer inpatient LOS
- Higher rates of discharge to post-acute care
- Higher rates of hospital readmission
- Impacts longer-term cognitive function (→ accelerated cognitive decline)
Delirium is deadly
Delirium in all acute care settings (ED, ICU, inpatient wards) is associated increased mortality
Delirium in older ED patients associated with higher mortality at:
- 30 days (6% vs 1%)
- 6 months (37% vs 14%)
AND...
Delirium is Preventable
References
Davis DH, et al. JAMA Psychiatry. 2017;74(3):244–251; Fong TG, et al. Neurology. 2009;72(18):1570–1575;
Han JH, et al. Acad Emerg Med. 2009;16(3):193–200
Han JH, et al. Ann Emerg Med. 2010;56(3):244–252
Han JH, et al. Emerg Med Clin North Am. 2010;28(3):611–631
Hustey FM, et al. Ann Emerg Med. 2002;39(3):248–253
Hustey FM, et al. Ann Emerg Med. 2003;41(5):678–684
Inouye SK, et al. Lancet. 2014;383(9920):911–922
Kennedy M, et al. J Am Geriatr Soc. 2014;62(3):462–469