• Donna M Fick, Melinda R Steis, Jennifer L Waller, and Sharon K Inouye.
• School of Nursing, The Pennsylvania State University, University Park, Pennsylvania; Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
• J Hosp Med. 2013 Sep 1; 8 (9): 500505500-5.

BackgroundCurrent literature does not identify the significance of underlying cognitive impairment and delirium in older adults during and 30 days following acute care hospitalization.ObjectiveDescribe the incidence, risk factors, and outcomes associated with incident delirium superimposed on dementia.DesignA 24-month prospective cohort study.SettingCommunity hospital.PatientsA total of 139 older adults (>65 years) with dementia.MethodsThis prospective study followed patients daily during hospitalization and 1 month posthospital. Main measures included dementia (Modified Blessed Dementia Rating score, Informant Questionnaire on Cognitive Decline in the Elderly), daily mental status change, dementia stage/severity (Clinical Dementia Rating, Global Deterioration Scale), delirium (Confusion Assessment Method), and delirium severity (Delirium Rating Scale-Revised-98). All statistical analysis was performed using SAS 9.3, and significance was an α level of 0.05. Logistic regression, analysis of covariance, or linear regression was performed controlling for age, gender, and dementia stage.ResultsThe overall incidence of new delirium was 32% (44/139). Those with delirium had a 25% short-term mortality rate, increased length of stay, and poorer function at discharge. At 1 month follow-up, subjects with delirium had greater functional decline. Males were more likely to develop delirium, and for every 1 unit increase in dementia severity (Global Deterioration Scale), subjects were 1.5 times more likely to develop delirium.ConclusionsDelirium prolongs hospitalization for persons with dementia. Thus, interventions to increase early detection of delirium have the potential to decrease the severity and duration of delirium and to prevent unnecessary suffering and costs from the complications of delirium and unnecessary readmissions to the hospital.Copyright © 2013 Society of Hospital Medicine.

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