Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: Results of a prospective multi-centre study on World Delirium Awareness Day

Carly Welch, Lauren McCluskey, Daisy Wilson, George E. Chapman, Thomas A. Jackson, Jonathan Treml, Daniel Davis, Emma Cunningham, Claire Copeland, Terrence Quinn, Thomas Pinkney, Rahul Mahida, Peter Nightingale, Sarah Richardson, Oliver Todd, Ruth Willott, Kelli Torsney, Mary Ni Lochlainn, Kumudhini Giridharan, Natalie CoxJane Masoli, Lindsay Ronan, Victoria Gaunt, Benjamin Jelley, Joanne Taylor, Roisin Healy, Emily Rose, Megan Parkinson, Ajay MacHarouthu, Eilidh McKenzie, Roisin McCormack, Jasmine Hart, Alison McCulloch, Neil Henderson, Louise Beveridge, Emma Elliott, Bogna Drozdowska, Martin Taylor-Rowan, Natasha Christodoulides, James Allen, Harriet Brown, Jennifer Champion, Riana Patel, Ghazal Hodhody, Kara Mayor, Christopher James Miller, Mark Studley, Vishnu Prasad, Emma Mumtaz, Sam Cohen, Sherif Abdelbadiee, Anna Lewis, Bushra Khizar, Hannah Pendleton, Teresa Harkin, Steve Rutter, Ayoub Behbahani, Abolfazl Behbahani, Ani Tencheva, Rachel King, Laura Jones, Alex Hornsby, Robbie Horton, Kate Foster, Kirsty Moore, Vincent McCormack, Matthew Kearney, Emma Fisken, Rory Durcan, Elizabeth Deacon, Jane Noble, Arunkumar Annamalai, Roxana Taranu, Michael Sen, Pryankaran Mithrakumar, Laura Briggs, Jamal Bhatti, Shiv Bhakta, Amaka Achara, Elizabeth Ellis, Sejlo Koshedo, Ayesha Aamir, Edward Wu, Abdullah B. Khalid, Parrthiepan Visvaratnam, Ijeoma Obi, Nader Nashed, Chioma Iwu, Sneha Gurung, Shonit Nagumantry, Olugbenro Akintade, Valerie Page, Kwasi Debrah, Katie Ball, Jabed Ahmed, Zhao Xiao Bei, Sarah B. McClelland, Michael Haley, Norman Pang, Andre Le Poideven, Emily Moore, Freya Cooper, Natalie Grundmann, Elizabeth Lonsdale-Eccles, Janine Valentine, Emma Stratton, Emily Bowen, Miriam Thake, Dorothy Kuek, Wioletta Pyc, Deborah Scott, Frances Rickard, Natalie Gaskell, Helen McDonald, Victoria Gaent, Sam Mills, Stuart Winearls, Paapa A-Odame, Ciaran Barlow, Isabelle Nicholls, Emma Norman, Kim Kirrane, Peter Jackson, Christian Chourot, Laura Jayne Beeley, Aaron Kay, Victoria Clayton, John Marshall, Hannah Morgan, George Naish, Clare Hunt, Rajeev Mishra, Saurav Bhattacharya, Nisha Rai, Ahmad Alareed, Clementine Anderson, Ganapathy Bhat, Sandra Darko, Pedro Vila De Mucha, David Saliu, Karen Beharry, Laurence Caines, Sanojan Bremakumar, Daniel Furmedge, Celine Bultynck, Esther Hindley, Elaine Seymour, Darmiga Thayabaran, Cal Doherty, John Frewen, Oluwatosin O. Abiola, Simon Tetlow, Guy Tinson, Olivia Morrow, Isabel Greaves, Rachael Bygate, Aayenah Yunus, Catherine Bryant, Howell Jones, Helen Bowden, Rose Laud, Keziah Austin, Farrah Bahsoon, Martin Glasser, Khai Lee Cheah, James Speed, Lucy Porter, James Dove, Katrin Hoffman, Olivia Evans, Taran Nandra, Leeying Giet, Simon Stapley, Imola Bargaoanu, Ismail Kadir, Adam McClean, Pranav Mishra, Katie Houldershaw, Ana Andrusca, Emmy Abu, Adam Swietoslawski, Bilquis Ahmed, Matthew Ansell, Saad Abdullah, Shoaib Iqbal, James Wilcockson, Angela Kabia, Karthika Velusamy, Nihaad Syed, Charlotte Chuter, Hamza Ahmed, Sarah Ahmad, Gladys Ofoche, Jacqueline Ibanichuka, Alice Wheeler, Angharad Chilton, Zainab Hussain, Felicia Tan, Sinead Quinn, Paul Croft, Amy Walker, Charlotte Bell, Claire Wilkes, Eliza Griffiths, James Reid, Ahmed Abras, Muhammad Adam, Awolkhier Mohammedseid-Nurhussien, Sohail Shakeel, Zarah Amin, Georgia R. Layton, Nathan Ingamells, Jemima Taylor, Luke Wynne, Wan Idoracaera Calisa Ikhwan, Hanna Waraich, Olivia Cooper, Philip Thomas, Emily Williamson, Huma Naqvi, Helena Lee, Elizabeth Holmes, Megan Offer, Alex McQuillan, Emma Jay, Hannah Currie, Sureena Janagal, Gary Kumbun, Rodric Jenkin, Holly Jacques, James Gaywood, Laura Babb, Moe Su Su San, Sasha Porter-Bent, Daisy Wilson, Tarunya Vedutla, Asiodu Nneamaka, Anum Cheema, Hannah Moorey, Asma Khan, Zeinab Majid, Puja Jatti, Abhishek Gupta, Tammy Lee, Helen Chamberlain, Clare Hughes, Alexis Giles, Tamsin Critchlow, Bethan Morgan, Alice Moseley, Grace Fennelly, Sophie Pettler, Edward Bilton, Emma Astaire, William McKeown, Katherine Williamson, Caroline Rice, Sharan Ramakrishna, Zahid Subhan, Nedaa Haddad, Anjli Krishan

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Abstract

Background: Delirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes. Methods: We conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions. Results: The point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4-6 (frail) (OR 4.80, CI 2.63-8.74), 7-9 (very frail) (OR 9.33, CI 4.79-18.17), compared to 1-3 (fit). However, higher CFS was associated with reduced delirium recognition (7-9 compared to 1-3; OR 0.16, CI 0.04-0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75-5.07) and increased mortality (OR 2.43, CI 1.44-4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67-11.21). Conclusions: Delirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

Original languageEnglish
Article number229
JournalBMC Medicine
Volume17
Issue number1
DOIs
Publication statusPublished - 14 Dec 2019
Externally publishedYes

Keywords

  • Collaboration
  • Delirium
  • Frailty
  • Older adults

ASJC Scopus subject areas

  • Medicine(all)

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