The relationship between frailty and delirium: insights from the 2017 Delirium Day study

• DOI: 10.1093/ageing/afab042
• Publication Date: 2021-03-26T12:09:07Z
• Authors: Paolo Mazzola; Elena Tassistro; Simona Di Santo; Emanuela Rossi; Anita Andreano; Maria Grazia Vals...; Antonio Cherubini; Alessandra Marengoni; Enrico Mossello; Mario Bo; Marco Inzitari; Mauro Di Bari; Cristina Udina; Nicola Latronico; Ciro Paolillo; Alessandro Morandi; Giuseppe Bellelli
• Keywords: Aged, 80 and over; Frailty; Delirium Day; Delirium Day, delirium, frailty, mortality, older people; Delirium; frailty; mortality; 3. Good health; Delirium Day; delirium; frailty; mortality; older people; older people; 03 medical and health sciences; delirium; 0302 clinical medicine; delirium; Delirium Day; frailty; mortality; older people; Aged; Aged, 80 and over; Geriatric Assessment; Humans; Prospective Studies; Risk Factors; Delirium; Frailty; Delirium; Delirium Day; frailty; mortality; older people; Risk Factors; Humans; Prospective Studies; delirium; Delirium Day; frailty; mortality; older people;; Geriatric Assessment; Aged

Abstract

Background although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality.

Objective to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients’ 30-day survival.

Design observational study nested in the Delirium Day project, with 30-day follow-up.

Setting acute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy.

Subjects a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards.

Methods a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days.

Results overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45–1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41–1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27–2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33–2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28–2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting.

Conclusions in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality.