Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery
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Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks.
We determined the incidence, risk factors, morbidity, and mortality of prolonged delirium in elderly patients after hip fracture surgery.
Patients and Methods
We evaluated 232 elderly patients (older than 65 years) (232 hips) who underwent hip fracture surgery for the development and duration of delirium and categorized them into three groups; nondelirium group, transient (≤ 4 weeks) delirium group, and prolonged (> 4 weeks) delirium group. Patients underwent a global geriatric evaluation, which included postoperative complications, mortality, and functional and mental status evaluations. The three groups were compared with respect to these variables.
Seventy patients (30.2%) had delirium develop, and among these, 14 (20%) had prolonged delirium with a total incidence of 6%. Multivariate analysis showed preinjury dementia was a risk factor of prolonged delirium. At the final followup, five (62.5%) of the eight patients who were ambulatory outdoors in the prolonged delirium group became housebound, whereas only 18 (16.4%) of the 110 patients who were ambulatory outdoors in the nondelirium group became housebound. Survival at 40 months was 81.0% (95% confidence interval, 72.6%–89.3%) in the nondelirium group and 63.6% (95% confidence interval, 35.2%–92.1%) in the prolonged delirium group.
Prolonged delirium was found to be associated with a poor functional outcome and increased mortality.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Blass JP, Gibson GE. Cerebrometabolic aspects of delirium in relationship to dementia. Dement Geriatr Cogn Disord. 1999;10:335–338. CrossRef
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383. CrossRef
- Chiam PC, Ng TP, Tan LL, Ong PS, Ang A, Kua EH. Prevalence of dementia in Singapore: results of the National Mental Health Survey of the Elderly 2003. Ann Acad Med Singapore. 2004;33(5 suppl):S14–S15.
- Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing. 2009;38:19–26. CrossRef
- Cole MG, McCusker J, Dendukuri N, Han L. Symptoms of delirium among elderly medical inpatients with or without dementia. J Neuropsychiatry Clin Neurosci. 2002;14:167–175. CrossRef
- Edlund A, Lundstrom M, Lundstrom G, Hedqvist B, Gustafson Y. Clinical profile of delirium in patients treated for femoral neck fractures. Dement Geriatr Cogn Disord. 1999;10:325–329. CrossRef
- Evans DA, Funkenstein HH, Albert MS, Scherr PA, Cook NR, Chown MJ, Hebert LE, Hennekens CH, Taylor JO. Prevalence of Alzheimer’s disease in a community population of older persons: higher than previously reported. JAMA. 1989;262:2551–2556. CrossRef
- Fabbri RM, Moreira MA, Garrido R, Almeida OP. Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly. Arq Neuropsiquiatr. 2001;59:175–179. CrossRef
- Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. CrossRef
- Francis J, Kapoor WN. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc. 1992;40:601–606.
- Freeman GB, Mykytyn V, Gibson GE. Differential alteration of dopamine, acetylcholine, and glutamate release during anoxia and/or 3,4-diaminopyridine treatment. Neurochem Res. 1987;12:1019–1027. CrossRef
- Gustafson Y, Berggren D, Brannstrom B, Bucht G, Norberg A, Hansson LI, Winblad B. Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc. 1988;36:525–530.
- Hofman A, Rocca WA, Brayne C, Breteler MM, Clarke M, Cooper B, Copeland JR, Dartigues JF, da Silva Droux A, Hagnell O, et al. The prevalence of dementia in Europe: a collaborative study of 1980–1990 findings. Eurodem Prevalence Research Group. Int J Epidemiol. 1991;20:736–748. CrossRef
- Horikawa N, Yamazaki T, Miyamoto K, Kurosawa A, Oiso H, Matsumoto F, Nishimura K, Karasawa K, Takamatsu K. Treatment for delirium with risperidone: results of a prospective open trial with 10 patients. Gen Hosp Psychiatry. 2003;25:289–292. CrossRef
- Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–948.
- Inouye SK, Zhang Y, Jones RN, Kiely DK, Yang F, Marcantonio ER. Risk factors for delirium at discharge: development and validation of a predictive model. Arch Intern Med. 2007;167:1406–1413. CrossRef
- Jitapunkul S, Pillay I, Ebrahim S. Delirium in newly admitted elderly patients: a prospective study. Q J Med. 1992;83:307–314.
- Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand. 1987;76:465–479. CrossRef
- Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481. CrossRef
- Kelly KG, Zisselman M, Cutillo-Schmitter T, Reichard R, Payne D, Denman SJ. Severity and course of delirium in medically hospitalized nursing facility residents. Am J Geriatr Psychiatry. 2001;9:72–77.
- Kiely DK, Bergmann MA, Jones RN, Murphy KM, Orav EJ, Marcantonio ER. Characteristics associated with delirium persistence among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci. 2004;59:344–349. CrossRef
- Kiely DK, Marcantonio ER, Inouye SK, Shaffer ML, Bergmann MA, Yang FM, Fearing MA, Jones RN. Persistent delirium predicts greater mortality. J Am Geriatr Soc. 2009;57:55–61. CrossRef
- Kim J, Jeong I, Chun JH, Lee S. The prevalence of dementia in a metropolitan city of South Korea. Int J Geriatr Psychiatry. 2003;18:617–622. CrossRef
- Koizumi J, Shiraishi H, Ofuku K, Suzuki T. Duration of delirium shortened by the correction of electrolyte imbalance. Jpn J Psychiatry Neurol. 1988;42:81–88.
- Kolbeinsson H, Jonsson A. Delirium and dementia in acute medical admissions of elderly patients in Iceland. Acta Psychiatr Scand. 1993;87:123–127. CrossRef
- Koponen H, Stenback U, Mattila E, Soininen H, Reinikainen K, Riekkinen PJ. Delirium among elderly persons admitted to a psychiatric hospital: clinical course during the acute stage and one-year follow-up. Acta Psychiatr Scand. 1989;79:579–585. CrossRef
- Kua EH. The prevalence of dementia in elderly Chinese. Acta Psychiatr Scand. 1991;83:350–352. CrossRef
- Kua EH, Ko SM. Prevalence of dementia among elderly Chinese and Malay residents of Singapore. Int Psychogeriatr. 1995;7:439–446. CrossRef
- Lipowski ZJ. Delirium in the elderly patient. N Engl J Med. 1989;320:578–582. CrossRef
- Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000;48:618–624.
- McAvay GJ, Van Ness PH, Bogardus ST Jr, Zhang Y, Leslie DL, Leo-Summers LS, Inouye SK. Older adults discharged from the hospital with delirium: 1-year outcomes. J Am Geriatr Soc. 2006;54:1245–1250. CrossRef
- McCusker J, Cole M, Dendukuri N, Han L, Belzile E. The course of delirium in older medical inpatients: a prospective study. J Gen Intern Med. 2003;18:696–704. CrossRef
- Mullen JO, Mullen NL. Hip fracture mortality: a prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res. 1992;280:214–222.
- Mungas D. In-office mental status testing: a practical guide. Geriatrics. 1991;46:54–58, 63, 66.
- Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–243. CrossRef
- Plum F. Dementia: an approaching epidemic. Nature. 1979;279:372–373. CrossRef
- Robertson BD, Robertson TJ. Postoperative delirium after hip fracture. J Bone Joint Surg Am. 2006;88:2060–2068. CrossRef
- Rockwood K. Acute confusion in elderly medical patients. J Am Geriatr Soc. 1989;37:150–154.
- Rockwood K. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol. 1993;48:M162–M166.
- Rudberg MA, Pompei P, Foreman MD, Ross RE, Cassel CK. The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity. Age Ageing. 1997;26:169–174. CrossRef
- Sahadevan S, Saw SM, Gao W, Tan LC, Chin JJ, Hong CY, Venketasubramanian N. Ethnic differences in Singapore’s dementia prevalence: the stroke, Parkinson’s disease, epilepsy, and dementia in Singapore study. J Am Geriatr Soc. 2008;56:2061–2068. CrossRef
- Schwartz TL, Masand PS. The role of atypical antipsychotics in the treatment of delirium. Psychosomatics. 2002;43:171–174. CrossRef
- Sirois F. Delirium: 100 cases. Can J Psychiatry. 1988;33:375–378.
- Winawer N. Postoperative delirium. Med Clin North Am. 2001;85:1229–1239. CrossRef
- Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery
Clinical Orthopaedics and Related Research®
Volume 469, Issue 9 , pp 2612-2620
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- 1. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- 2. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
- 3. Department of Anesthesiology, Chung-Ang University College of Medicine, Seoul, South Korea