Volume 53, Issue 6 p. 963-969

Outcomes of Older People Admitted to Postacute Facilities with Delirium

Edward R. Marcantonio MD, SM

Edward R. Marcantonio MD, SM

From the * Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts Research and Training Institute, Hebrew Senior Life, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts § Division on Aging, Harvard Medical School, Boston, Massachusetts.

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Dan K. Kiely MPH, MA

Dan K. Kiely MPH, MA

From the * Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts Research and Training Institute, Hebrew Senior Life, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts § Division on Aging, Harvard Medical School, Boston, Massachusetts.

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Samuel E. Simon MA

Samuel E. Simon MA

From the * Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts Research and Training Institute, Hebrew Senior Life, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts § Division on Aging, Harvard Medical School, Boston, Massachusetts.

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E. John Orav PhD

E. John Orav PhD

From the * Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts Research and Training Institute, Hebrew Senior Life, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts § Division on Aging, Harvard Medical School, Boston, Massachusetts.

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Richard N. Jones ScD

Richard N. Jones ScD

From the * Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts Research and Training Institute, Hebrew Senior Life, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts § Division on Aging, Harvard Medical School, Boston, Massachusetts.

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Katharine M. Murphy RN, PhD

Katharine M. Murphy RN, PhD

From the * Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts Research and Training Institute, Hebrew Senior Life, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts § Division on Aging, Harvard Medical School, Boston, Massachusetts.

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Margaret A. Bergmann GNP, MS

Margaret A. Bergmann GNP, MS

From the * Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts Research and Training Institute, Hebrew Senior Life, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts § Division on Aging, Harvard Medical School, Boston, Massachusetts.

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First published: 31 May 2005
Citations: 201
Address correspondence to Edward R. Marcantonio, MD, SM, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose 118, Boston, MA 02215. E-mail: [email protected]

Funded in part by National Institute on Aging Grant RO1AG17649. Dr. Marcantonio is a Paul Beeson Physician Faculty Scholar in Aging Research.
Presented in abstract form at the national meeting of the American Geriatrics Society, Washington, DC, May 2002.

Abstract

Objectives: To compare outcomes of patients admitted to postacute skilled nursing facilities with delirium, subsyndromal delirium, and no delirium.

Design: Observational cohort study.

Setting: Seven skilled nursing facilities that specialize in postacute care within a single metropolitan region.

Participants: Five hundred four subjects chosen from 1,248 consenting subjects aged 65 and older who underwent mental status testing within 5 days of admission to the participating facilities. Subjects who met full Confusion Assessment Method (CAM) criteria were classified as delirious, those with one or more CAM criteria were classified as having subsyndromal delirium, and those with no CAM features were classified as having no delirium. All subjects with delirium and with available medical records were included. A random subset of subjects with no delirium and subsyndromal delirium with available medical records was included.

Measurements: The medical records of all subjects underwent a structured review by trained research nurses who were masked to the subjects' initial delirium status. Records were reviewed for the development of new complications within the postacute setting and to determine whether the subjects were discharged within 30 days and, if so, the discharge destination. The National Death Index was used to assess 6-month mortality.

Results: Subjects with delirium were more likely to experience one or more complications than subjects with no delirium (73% vs 41%, P < .01). Within 30 days of postacute admission, subjects with delirium were more than twice as likely to be rehospitalized (30% vs 13%), and less than half as likely to be discharged to the community (30% vs 73%) than subjects without delirium (differences P < .01). Subjects with subsyndromal delirium had outcomes intermediate between those with and without delirium. Finally, subjects admitted to the postacute setting with delirium experienced a 6-month mortality rate of 25.0%, compared with 5.7% in subjects admitted without delirium. Subjects with subsyndromal delirium had a 6-month mortality rate of 18.3%.

Conclusion: Patients admitted to postacute skilled nursing facilities with delirium are more likely to experience complications, rehospitalization, and death than patients without delirium. These findings support the need for improved case finding and management of delirium in postacute care.