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Abstract
Delirium has been defined as fluctuation in the level of consciousness, attention and cognition of acute onset, over hours to days, sometimes accompanied by delusions and hallucinations.
Delirium is common among older patients in acute care hospitals. At time of admission to a hospital, 10%-20% of older adults meet the diagnostic criteria for delirium, and another 25%-60% develop delirium during the course of their hospitalization. Despite this high prevalence of delirium an estimated 32%-67% of cases go unrecognized on general medical units.
Types of delirium include hypoactive, hyperactive, mixed type.
Delirium has non-modifiable (predisposing) risk factors and potentially modifiable (precipitating) risk factors.
Delirium is associated with adverse effects as physical, cognitive impairment and increased costs to healthcare services also prolongs the hospital stay, increased rates of nursing home placement on discharge, worsens the functional status and increases the mortality rate.
Delirium was showed to be an independent marker for increased mortality. Mortality outcome of delirium is variable ranging from 14.5%-37%
The estimated 3-month mortality among hospitalized elderly patients with delirium ranges from 23% to 33% and the 1-year mortality may be as high as 50%.
Diagnosis of delirium depend on history, physical examination, some laboratory investigations and neuroimaging may be beneficial in some cases, assessment tools include the Confusion Assessment Method (CAM), the Delirium Rating Scale Revised (DRS) and the Delirium Symptom Interview (DSI).
The aim of this study is to estimate the effect of delirium on 3-month mortality in elderly patients.
It is a prospective cohort study carried out on 114 elderly patients (52 cases and 62 control) recruited from geriatric department and ICU and internal medicine department. They were subjected to assessment of delirium within 48 hours using the confusion assessment method, and then followed up for 3 months to assess mortality outcome.
Exclusion was done for those who were under age of 60 years, patients with dementia, terminally ill patients (metastatic cancer, end stage respiratory and renal failure, liver cell failure, acute congestive heart failure) and patients with communication difficulties (sever deafness & aphasia).
The study showed that delirium is an independent marker for increased mortality among elderly patients within 3 months follow-up.