Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Waleed Faheem; Taran Nandra; Sarah Richardson; David Saliu; Daisy Wilson; Thomas A. Jackson; Laura Magill; Lauren McCluskey; Rita Perry; Carly Welch; Daisy Wilson; Claire Copeland; Emma L. Cunningham; Daniel Davis; Jonathan Treml; Thomas Pinkney; Terrence Quinn; Peter Nightingale; Benjamin Jelley; Victoria Gaunt; Mary Ni Lochlainn; Kumudhini Giridharan; Mustafa Alsahab; Stephen Makin; Kelli Torsney; Jane Masoli; Lindsay Ronan; Jenni K. Burton; Oliver Todd; Joanne Taylor; Ruth Willott; Natalie Cox; Roisin Healy; Nedaa Haddad; Sharan Ramakrishna; Zahid Subhan; Antonella Mazzoleni; Olga Nynaes; Jodie Crofts; Emily McNicholas; Jonathan Baillie; Sophie J. Irwin; Dominic Kelly; Eleanor Leah; Jenny Evans; Mark A. Bowman; Sinead Quinn; Joseph B. Wilson; Clare Hughes; Emily Moore; Geriatric Medicine Research Collaborative

doi:10.1007/s41999-022-00737-y

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Waleed Faheem
, Taran Nandra
, Sarah Richardson
, David Saliu
, Daisy Wilson
, Thomas A. Jackson
, Laura Magill
, Lauren McCluskey
, Rita Perry
, Carly Welch
, Daisy Wilson
, Claire Copeland
, Emma L. Cunningham
, Daniel Davis
, Jonathan Treml
, Thomas Pinkney
, Terrence Quinn
, Peter Nightingale
, Benjamin Jelley
, Victoria Gaunt

Mary Ni Lochlainn, Kumudhini Giridharan, Mustafa Alsahab, Stephen Makin, Kelli Torsney, Jane Masoli, Lindsay Ronan, Jenni K. Burton, Oliver Todd, Joanne Taylor, Ruth Willott, Natalie Cox, Roisin Healy, Nedaa Haddad, Sharan Ramakrishna, Zahid Subhan, Antonella Mazzoleni, Olga Nynaes, Jodie Crofts, Emily McNicholas, Jonathan Baillie, Sophie J. Irwin, Dominic Kelly, Eleanor Leah, Jenny Evans, Mark A. Bowman, Sinead Quinn, Joseph B. Wilson, Clare Hughes, Emily Moore, Geriatric Medicine Research Collaborative

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

112 Downloads (Pure)

Abstract

Purpose

Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom.

Methods
Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded.

Results
The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia.

Conclusion
We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.

Original language	English
Pages (from-to)	325-332
Number of pages	8
Journal	European Geriatric Medicine
Volume	14
Issue number	2
Early online date	25 Jan 2023
DOIs	https://doi.org/10.1007/s41999-022-00737-y
Publication status	Published - Apr 2023

Bibliographical note

Funding Information:
The research was sponsored by the University of Birmingham. This study received support for project delivery and coordination from the Birmingham Surgical Trials Consortium via core funding from the National Institute for Health Research (NIHR) Clinical Research Network West Midlands allocated to help support new research collaboratives. The sponsor was not involved in design, methods, subject recruitment, data collections, analysis, or preparation of the manuscript. The views expressed in this manuscript are those of the authors are not the NIHR, National Health Service, or Department of Health.

Publisher Copyright:
© 2023, The Author(s).

Keywords

Delirium
Frailty
Mortality
Recognition

ASJC Scopus subject areas

Gerontology
Geriatrics and Gerontology

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Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study
Copyright 2023 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
Final published version, 749 KBLicence: CC BY

Cite this

Faheem, W., Nandra, T., Richardson, S., Saliu, D., Wilson, D., Jackson, T. A., Magill, L., McCluskey, L., Perry, R., Welch, C., Wilson, D., Copeland, C., Cunningham, E. L., Davis, D., Treml, J., Pinkney, T., Quinn, T., Nightingale, P., Jelley, B., ... Geriatric Medicine Research Collaborative (2023). Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study. European Geriatric Medicine, 14(2), 325-332. https://doi.org/10.1007/s41999-022-00737-y

@article{d2eee69ba0c544d2b3b0e802956a44da,

title = "Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study",

abstract = "Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3\% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.",

keywords = "Delirium, Frailty, Mortality, Recognition",

author = "Waleed Faheem and Taran Nandra and Sarah Richardson and David Saliu and Daisy Wilson and Jackson, \{Thomas A.\} and Laura Magill and Lauren McCluskey and Rita Perry and Carly Welch and Daisy Wilson and Claire Copeland and Cunningham, \{Emma L.\} and Daniel Davis and Jonathan Treml and Thomas Pinkney and Terrence Quinn and Peter Nightingale and Benjamin Jelley and Victoria Gaunt and Lochlainn, \{Mary Ni\} and Kumudhini Giridharan and Mustafa Alsahab and Stephen Makin and Kelli Torsney and Jane Masoli and Lindsay Ronan and Burton, \{Jenni K.\} and Oliver Todd and Joanne Taylor and Ruth Willott and Natalie Cox and Roisin Healy and Nedaa Haddad and Sharan Ramakrishna and Zahid Subhan and Antonella Mazzoleni and Olga Nynaes and Jodie Crofts and Emily McNicholas and Jonathan Baillie and Irwin, \{Sophie J.\} and Dominic Kelly and Eleanor Leah and Jenny Evans and Bowman, \{Mark A.\} and Sinead Quinn and Wilson, \{Joseph B.\} and Clare Hughes and Emily Moore and \{Geriatric Medicine Research Collaborative\}",

note = "Funding Information: The research was sponsored by the University of Birmingham. This study received support for project delivery and coordination from the Birmingham Surgical Trials Consortium via core funding from the National Institute for Health Research (NIHR) Clinical Research Network West Midlands allocated to help support new research collaboratives. The sponsor was not involved in design, methods, subject recruitment, data collections, analysis, or preparation of the manuscript. The views expressed in this manuscript are those of the authors are not the NIHR, National Health Service, or Department of Health. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = apr,

doi = "10.1007/s41999-022-00737-y",

language = "English",

volume = "14",

pages = "325--332",

journal = "European Geriatric Medicine",

issn = "1878-7649",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "2",

}

Faheem, W, Nandra, T, Richardson, S, Saliu, D, Wilson, D, Jackson, TA, Magill, L, McCluskey, L, Perry, R, Welch, C, Wilson, D, Copeland, C, Cunningham, EL, Davis, D, Treml, J, Pinkney, T, Quinn, T, Nightingale, P, Jelley, B, Gaunt, V, Lochlainn, MN, Giridharan, K, Alsahab, M, Makin, S, Torsney, K, Masoli, J, Ronan, L, Burton, JK, Todd, O, Taylor, J, Willott, R, Cox, N, Healy, R, Haddad, N, Ramakrishna, S, Subhan, Z, Mazzoleni, A, Nynaes, O, Crofts, J, McNicholas, E, Baillie, J, Irwin, SJ, Kelly, D, Leah, E, Evans, J, Bowman, MA, Quinn, S, Wilson, JB, Hughes, C, Moore, E & Geriatric Medicine Research Collaborative 2023, 'Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study', European Geriatric Medicine, vol. 14, no. 2, pp. 325-332. https://doi.org/10.1007/s41999-022-00737-y

TY - JOUR

T1 - Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

AU - Faheem, Waleed

AU - Nandra, Taran

AU - Richardson, Sarah

AU - Saliu, David

AU - Wilson, Daisy

AU - Jackson, Thomas A.

AU - Magill, Laura

AU - McCluskey, Lauren

AU - Perry, Rita

AU - Welch, Carly

AU - Wilson, Daisy

AU - Copeland, Claire

AU - Cunningham, Emma L.

AU - Davis, Daniel

AU - Treml, Jonathan

AU - Pinkney, Thomas

AU - Quinn, Terrence

AU - Nightingale, Peter

AU - Jelley, Benjamin

AU - Gaunt, Victoria

AU - Lochlainn, Mary Ni

AU - Giridharan, Kumudhini

AU - Alsahab, Mustafa

AU - Makin, Stephen

AU - Torsney, Kelli

AU - Masoli, Jane

AU - Ronan, Lindsay

AU - Burton, Jenni K.

AU - Todd, Oliver

AU - Taylor, Joanne

AU - Willott, Ruth

AU - Cox, Natalie

AU - Healy, Roisin

AU - Haddad, Nedaa

AU - Ramakrishna, Sharan

AU - Subhan, Zahid

AU - Mazzoleni, Antonella

AU - Nynaes, Olga

AU - Crofts, Jodie

AU - McNicholas, Emily

AU - Baillie, Jonathan

AU - Irwin, Sophie J.

AU - Kelly, Dominic

AU - Leah, Eleanor

AU - Evans, Jenny

AU - Bowman, Mark A.

AU - Quinn, Sinead

AU - Wilson, Joseph B.

AU - Hughes, Clare

AU - Moore, Emily

AU - Geriatric Medicine Research Collaborative

N1 - Funding Information: The research was sponsored by the University of Birmingham. This study received support for project delivery and coordination from the Birmingham Surgical Trials Consortium via core funding from the National Institute for Health Research (NIHR) Clinical Research Network West Midlands allocated to help support new research collaboratives. The sponsor was not involved in design, methods, subject recruitment, data collections, analysis, or preparation of the manuscript. The views expressed in this manuscript are those of the authors are not the NIHR, National Health Service, or Department of Health. Publisher Copyright: © 2023, The Author(s).

PY - 2023/4

Y1 - 2023/4

N2 - Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.

AB - Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.

KW - Delirium

KW - Frailty

KW - Mortality

KW - Recognition

U2 - 10.1007/s41999-022-00737-y

DO - 10.1007/s41999-022-00737-y

M3 - Article

C2 - 36696045

AN - SCOPUS:85152973891

SN - 1878-7649

VL - 14

SP - 325

EP - 332

JO - European Geriatric Medicine

JF - European Geriatric Medicine

IS - 2

ER -

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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