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 language | English |
|---|---|
| Article number | 229 |
| Journal | BMC Medicine |
| Volume | 17 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 14 Dec 2019 |
| Externally published | Yes |
Keywords
- Collaboration
- Delirium
- Frailty
- Older adults
ASJC Scopus subject areas
- Medicine(all)
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- 10.1186/s12916-019-1458-7Licence: CC BY
- Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multicentre study on World Delirium Awareness Day
Copyright 2019 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
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Delirium is prevalent in older hospital inpatients and associated with adverse outcomes : Results of a prospective multi-centre study on World Delirium Awareness Day. / Welch, Carly; McCluskey, Lauren; Wilson, Daisy; Chapman, George E.; Jackson, Thomas A.; Treml, Jonathan; Davis, Daniel; Cunningham, Emma; Copeland, Claire; Quinn, Terrence; Pinkney, Thomas; Mahida, Rahul; Nightingale, Peter; Richardson, Sarah; Todd, Oliver; Willott, Ruth; Torsney, Kelli; Ni Lochlainn, Mary; Giridharan, Kumudhini; Cox, Natalie; Masoli, Jane; Ronan, Lindsay; Gaunt, Victoria; Jelley, Benjamin; Taylor, Joanne; Healy, Roisin; Rose, Emily; Parkinson, Megan; MacHarouthu, Ajay; McKenzie, Eilidh; McCormack, Roisin; Hart, Jasmine; McCulloch, Alison; Henderson, Neil; Beveridge, Louise; Elliott, Emma; Drozdowska, Bogna; Taylor-Rowan, Martin; Christodoulides, Natasha; Allen, James; Brown, Harriet; Champion, Jennifer; Patel, Riana; Hodhody, Ghazal; Mayor, Kara; Miller, Christopher James; Studley, Mark; Prasad, Vishnu; Mumtaz, Emma; Cohen, Sam; Abdelbadiee, Sherif; Lewis, Anna; Khizar, Bushra; Pendleton, Hannah; Harkin, Teresa; Rutter, Steve; Behbahani, Ayoub; Behbahani, Abolfazl; Tencheva, Ani; King, Rachel; Jones, Laura; Hornsby, Alex; Horton, Robbie; Foster, Kate; Moore, Kirsty; McCormack, Vincent; Kearney, Matthew; Fisken, Emma; Durcan, Rory; Deacon, Elizabeth; Noble, Jane; Annamalai, Arunkumar; Taranu, Roxana; Sen, Michael; Mithrakumar, Pryankaran; Briggs, Laura; Bhatti, Jamal; Bhakta, Shiv; Achara, Amaka; Ellis, Elizabeth; Koshedo, Sejlo; Aamir, Ayesha; Wu, Edward; Khalid, Abdullah B.; Visvaratnam, Parrthiepan; Obi, Ijeoma; Nashed, Nader; Iwu, Chioma; Gurung, Sneha; Nagumantry, Shonit; Akintade, Olugbenro; Page, Valerie; Debrah, Kwasi; Ball, Katie; Ahmed, Jabed; Bei, Zhao Xiao; McClelland, Sarah B.; Haley, Michael; Pang, Norman; Le Poideven, Andre; Moore, Emily; Cooper, Freya; Grundmann, Natalie; Lonsdale-Eccles, Elizabeth; Valentine, Janine; Stratton, Emma; Bowen, Emily; Thake, Miriam; Kuek, Dorothy; Pyc, Wioletta; Scott, Deborah; Rickard, Frances; Gaskell, Natalie; McDonald, Helen; Gaent, Victoria; Mills, Sam; Winearls, Stuart; A-Odame, Paapa; Barlow, Ciaran; Nicholls, Isabelle; Norman, Emma; Kirrane, Kim; Jackson, Peter; Chourot, Christian; Beeley, Laura Jayne; Kay, Aaron; Clayton, Victoria; Marshall, John; Morgan, Hannah; Naish, George; Hunt, Clare; Mishra, Rajeev; Bhattacharya, Saurav; Rai, Nisha; Alareed, Ahmad; Anderson, Clementine; Bhat, Ganapathy; Darko, Sandra; Vila De Mucha, Pedro; Saliu, David; Beharry, Karen; Caines, Laurence; Bremakumar, Sanojan; Furmedge, Daniel; Bultynck, Celine; Hindley, Esther; Seymour, Elaine; Thayabaran, Darmiga; Doherty, Cal; Frewen, John; Abiola, Oluwatosin O.; Tetlow, Simon; Tinson, Guy; Morrow, Olivia; Greaves, Isabel; Bygate, Rachael; Yunus, Aayenah; Bryant, Catherine; Jones, Howell; Bowden, Helen; Laud, Rose; Austin, Keziah; Bahsoon, Farrah; Glasser, Martin; Cheah, Khai Lee; Speed, James; Porter, Lucy; Dove, James; Hoffman, Katrin; Evans, Olivia; Nandra, Taran; Giet, Leeying; Stapley, Simon; Bargaoanu, Imola; Kadir, Ismail; McClean, Adam; Mishra, Pranav; Houldershaw, Katie; Andrusca, Ana; Abu, Emmy; Swietoslawski, Adam; Ahmed, Bilquis; Ansell, Matthew; Abdullah, Saad; Iqbal, Shoaib; Wilcockson, James; Kabia, Angela; Velusamy, Karthika; Syed, Nihaad; Chuter, Charlotte; Ahmed, Hamza; Ahmad, Sarah; Ofoche, Gladys; Ibanichuka, Jacqueline; Wheeler, Alice; Chilton, Angharad; Hussain, Zainab; Tan, Felicia; Quinn, Sinead; Croft, Paul; Walker, Amy; Bell, Charlotte; Wilkes, Claire; Griffiths, Eliza; Reid, James; Abras, Ahmed; Adam, Muhammad; Mohammedseid-Nurhussien, Awolkhier; Shakeel, Sohail; Amin, Zarah; Layton, Georgia R.; Ingamells, Nathan; Taylor, Jemima; Wynne, Luke; Ikhwan, Wan Idoracaera Calisa; Waraich, Hanna; Cooper, Olivia; Thomas, Philip; Williamson, Emily; Naqvi, Huma; Lee, Helena; Holmes, Elizabeth; Offer, Megan; McQuillan, Alex; Jay, Emma; Currie, Hannah; Janagal, Sureena; Kumbun, Gary; Jenkin, Rodric; Jacques, Holly; Gaywood, James; Babb, Laura; San, Moe Su Su; Porter-Bent, Sasha; Wilson, Daisy; Vedutla, Tarunya; Nneamaka, Asiodu; Cheema, Anum; Moorey, Hannah; Khan, Asma; Majid, Zeinab; Jatti, Puja; Gupta, Abhishek; Lee, Tammy; Chamberlain, Helen; Hughes, Clare; Giles, Alexis; Critchlow, Tamsin; Morgan, Bethan; Moseley, Alice; Fennelly, Grace; Pettler, Sophie; Bilton, Edward; Astaire, Emma; McKeown, William; Williamson, Katherine; Rice, Caroline; Ramakrishna, Sharan; Subhan, Zahid; Haddad, Nedaa; Krishan, Anjli.
In: BMC Medicine, Vol. 17, No. 1, 229, 14.12.2019.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Delirium is prevalent in older hospital inpatients and associated with adverse outcomes
T2 - Results of a prospective multi-centre study on World Delirium Awareness Day
AU - Welch, Carly
AU - McCluskey, Lauren
AU - Wilson, Daisy
AU - Chapman, George E.
AU - Jackson, Thomas A.
AU - Treml, Jonathan
AU - Davis, Daniel
AU - Cunningham, Emma
AU - Copeland, Claire
AU - Quinn, Terrence
AU - Pinkney, Thomas
AU - Mahida, Rahul
AU - Nightingale, Peter
AU - Richardson, Sarah
AU - Todd, Oliver
AU - Willott, Ruth
AU - Torsney, Kelli
AU - Ni Lochlainn, Mary
AU - Giridharan, Kumudhini
AU - Cox, Natalie
AU - Masoli, Jane
AU - Ronan, Lindsay
AU - Gaunt, Victoria
AU - Jelley, Benjamin
AU - Taylor, Joanne
AU - Healy, Roisin
AU - Rose, Emily
AU - Parkinson, Megan
AU - MacHarouthu, Ajay
AU - McKenzie, Eilidh
AU - McCormack, Roisin
AU - Hart, Jasmine
AU - McCulloch, Alison
AU - Henderson, Neil
AU - Beveridge, Louise
AU - Elliott, Emma
AU - Drozdowska, Bogna
AU - Taylor-Rowan, Martin
AU - Christodoulides, Natasha
AU - Allen, James
AU - Brown, Harriet
AU - Champion, Jennifer
AU - Patel, Riana
AU - Hodhody, Ghazal
AU - Mayor, Kara
AU - Miller, Christopher James
AU - Studley, Mark
AU - Prasad, Vishnu
AU - Mumtaz, Emma
AU - Cohen, Sam
AU - Abdelbadiee, Sherif
AU - Lewis, Anna
AU - Khizar, Bushra
AU - Pendleton, Hannah
AU - Harkin, Teresa
AU - Rutter, Steve
AU - Behbahani, Ayoub
AU - Behbahani, Abolfazl
AU - Tencheva, Ani
AU - King, Rachel
AU - Jones, Laura
AU - Hornsby, Alex
AU - Horton, Robbie
AU - Foster, Kate
AU - Moore, Kirsty
AU - McCormack, Vincent
AU - Kearney, Matthew
AU - Fisken, Emma
AU - Durcan, Rory
AU - Deacon, Elizabeth
AU - Noble, Jane
AU - Annamalai, Arunkumar
AU - Taranu, Roxana
AU - Sen, Michael
AU - Mithrakumar, Pryankaran
AU - Briggs, Laura
AU - Bhatti, Jamal
AU - Bhakta, Shiv
AU - Achara, Amaka
AU - Ellis, Elizabeth
AU - Koshedo, Sejlo
AU - Aamir, Ayesha
AU - Wu, Edward
AU - Khalid, Abdullah B.
AU - Visvaratnam, Parrthiepan
AU - Obi, Ijeoma
AU - Nashed, Nader
AU - Iwu, Chioma
AU - Gurung, Sneha
AU - Nagumantry, Shonit
AU - Akintade, Olugbenro
AU - Page, Valerie
AU - Debrah, Kwasi
AU - Ball, Katie
AU - Ahmed, Jabed
AU - Bei, Zhao Xiao
AU - McClelland, Sarah B.
AU - Haley, Michael
AU - Pang, Norman
AU - Le Poideven, Andre
AU - Moore, Emily
AU - Cooper, Freya
AU - Grundmann, Natalie
AU - Lonsdale-Eccles, Elizabeth
AU - Valentine, Janine
AU - Stratton, Emma
AU - Bowen, Emily
AU - Thake, Miriam
AU - Kuek, Dorothy
AU - Pyc, Wioletta
AU - Scott, Deborah
AU - Rickard, Frances
AU - Gaskell, Natalie
AU - McDonald, Helen
AU - Gaent, Victoria
AU - Mills, Sam
AU - Winearls, Stuart
AU - A-Odame, Paapa
AU - Barlow, Ciaran
AU - Nicholls, Isabelle
AU - Norman, Emma
AU - Kirrane, Kim
AU - Jackson, Peter
AU - Chourot, Christian
AU - Beeley, Laura Jayne
AU - Kay, Aaron
AU - Clayton, Victoria
AU - Marshall, John
AU - Morgan, Hannah
AU - Naish, George
AU - Hunt, Clare
AU - Mishra, Rajeev
AU - Bhattacharya, Saurav
AU - Rai, Nisha
AU - Alareed, Ahmad
AU - Anderson, Clementine
AU - Bhat, Ganapathy
AU - Darko, Sandra
AU - Vila De Mucha, Pedro
AU - Saliu, David
AU - Beharry, Karen
AU - Caines, Laurence
AU - Bremakumar, Sanojan
AU - Furmedge, Daniel
AU - Bultynck, Celine
AU - Hindley, Esther
AU - Seymour, Elaine
AU - Thayabaran, Darmiga
AU - Doherty, Cal
AU - Frewen, John
AU - Abiola, Oluwatosin O.
AU - Tetlow, Simon
AU - Tinson, Guy
AU - Morrow, Olivia
AU - Greaves, Isabel
AU - Bygate, Rachael
AU - Yunus, Aayenah
AU - Bryant, Catherine
AU - Jones, Howell
AU - Bowden, Helen
AU - Laud, Rose
AU - Austin, Keziah
AU - Bahsoon, Farrah
AU - Glasser, Martin
AU - Cheah, Khai Lee
AU - Speed, James
AU - Porter, Lucy
AU - Dove, James
AU - Hoffman, Katrin
AU - Evans, Olivia
AU - Nandra, Taran
AU - Giet, Leeying
AU - Stapley, Simon
AU - Bargaoanu, Imola
AU - Kadir, Ismail
AU - McClean, Adam
AU - Mishra, Pranav
AU - Houldershaw, Katie
AU - Andrusca, Ana
AU - Abu, Emmy
AU - Swietoslawski, Adam
AU - Ahmed, Bilquis
AU - Ansell, Matthew
AU - Abdullah, Saad
AU - Iqbal, Shoaib
AU - Wilcockson, James
AU - Kabia, Angela
AU - Velusamy, Karthika
AU - Syed, Nihaad
AU - Chuter, Charlotte
AU - Ahmed, Hamza
AU - Ahmad, Sarah
AU - Ofoche, Gladys
AU - Ibanichuka, Jacqueline
AU - Wheeler, Alice
AU - Chilton, Angharad
AU - Hussain, Zainab
AU - Tan, Felicia
AU - Quinn, Sinead
AU - Croft, Paul
AU - Walker, Amy
AU - Bell, Charlotte
AU - Wilkes, Claire
AU - Griffiths, Eliza
AU - Reid, James
AU - Abras, Ahmed
AU - Adam, Muhammad
AU - Mohammedseid-Nurhussien, Awolkhier
AU - Shakeel, Sohail
AU - Amin, Zarah
AU - Layton, Georgia R.
AU - Ingamells, Nathan
AU - Taylor, Jemima
AU - Wynne, Luke
AU - Ikhwan, Wan Idoracaera Calisa
AU - Waraich, Hanna
AU - Cooper, Olivia
AU - Thomas, Philip
AU - Williamson, Emily
AU - Naqvi, Huma
AU - Lee, Helena
AU - Holmes, Elizabeth
AU - Offer, Megan
AU - McQuillan, Alex
AU - Jay, Emma
AU - Currie, Hannah
AU - Janagal, Sureena
AU - Kumbun, Gary
AU - Jenkin, Rodric
AU - Jacques, Holly
AU - Gaywood, James
AU - Babb, Laura
AU - San, Moe Su Su
AU - Porter-Bent, Sasha
AU - Wilson, Daisy
AU - Vedutla, Tarunya
AU - Nneamaka, Asiodu
AU - Cheema, Anum
AU - Moorey, Hannah
AU - Khan, Asma
AU - Majid, Zeinab
AU - Jatti, Puja
AU - Gupta, Abhishek
AU - Lee, Tammy
AU - Chamberlain, Helen
AU - Hughes, Clare
AU - Giles, Alexis
AU - Critchlow, Tamsin
AU - Morgan, Bethan
AU - Moseley, Alice
AU - Fennelly, Grace
AU - Pettler, Sophie
AU - Bilton, Edward
AU - Astaire, Emma
AU - McKeown, William
AU - Williamson, Katherine
AU - Rice, Caroline
AU - Ramakrishna, Sharan
AU - Subhan, Zahid
AU - Haddad, Nedaa
AU - Krishan, Anjli
PY - 2019/12/14
Y1 - 2019/12/14
N2 - 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.
AB - 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.
KW - Collaboration
KW - Delirium
KW - Frailty
KW - Older adults
U2 - 10.1186/s12916-019-1458-7
DO - 10.1186/s12916-019-1458-7
M3 - Article
C2 - 31837711
AN - SCOPUS:85076709280
VL - 17
JO - BMC Medicine
JF - BMC Medicine
SN - 1741-7015
IS - 1
M1 - 229
ER -