Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients

Alessandro Morandi, Daniel Davis, Donna M. Fick, Renato Turco, Malaz Boustani, Elena Lucchi, Fabio Guerini, Sara Morghen, Tiziana Torpilliesi, Simona Gentile, Alasdair M. MacLullich, Marco Trabucchi, Giuseppe Bellelli

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective: Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation. Design: Prospective cohort study. Setting: Hospital rehabilitation unit. Participants: A total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006. Measurements: Dementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations. Results: The median age was 77 years (interquartile range: 71-83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95% Confidence Interval [CI] 5.6-42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8-8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1-2.8; P = .01). Conclusions: DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.

Original languageEnglish
Pages (from-to)349-354
Number of pages6
JournalJournal of the American Medical Directors Association
Volume15
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Delirium
Dementia
Inpatients
Rehabilitation
Institutionalization
Logistic Models
Odds Ratio
Confidence Intervals
Diagnostic and Statistical Manual of Mental Disorders
Walking
Mortality
Hospital Units
Cohort Studies
Prospective Studies

Keywords

  • Delirium
  • Delirium-superimposed dementia
  • Dementia
  • Elderly
  • Institutionalization
  • Mobility
  • Mortality

ASJC Scopus subject areas

  • Medicine(all)
  • Nursing(all)
  • Health Policy

Cite this

Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. / Morandi, Alessandro; Davis, Daniel; Fick, Donna M.; Turco, Renato; Boustani, Malaz; Lucchi, Elena; Guerini, Fabio; Morghen, Sara; Torpilliesi, Tiziana; Gentile, Simona; MacLullich, Alasdair M.; Trabucchi, Marco; Bellelli, Giuseppe.

In: Journal of the American Medical Directors Association, Vol. 15, No. 5, 2014, p. 349-354.

Research output: Contribution to journalArticle

Morandi, A, Davis, D, Fick, DM, Turco, R, Boustani, M, Lucchi, E, Guerini, F, Morghen, S, Torpilliesi, T, Gentile, S, MacLullich, AM, Trabucchi, M & Bellelli, G 2014, 'Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients', Journal of the American Medical Directors Association, vol. 15, no. 5, pp. 349-354. https://doi.org/10.1016/j.jamda.2013.12.084
Morandi, Alessandro ; Davis, Daniel ; Fick, Donna M. ; Turco, Renato ; Boustani, Malaz ; Lucchi, Elena ; Guerini, Fabio ; Morghen, Sara ; Torpilliesi, Tiziana ; Gentile, Simona ; MacLullich, Alasdair M. ; Trabucchi, Marco ; Bellelli, Giuseppe. / Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. In: Journal of the American Medical Directors Association. 2014 ; Vol. 15, No. 5. pp. 349-354.
@article{2fcc13af17424163b7dd2423e58473ac,
title = "Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients",
abstract = "Objective: Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation. Design: Prospective cohort study. Setting: Hospital rehabilitation unit. Participants: A total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006. Measurements: Dementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations. Results: The median age was 77 years (interquartile range: 71-83). The prevalence of DSD was 8{\%}, and the prevalence of delirium and dementia alone were 4{\%} and 22{\%}, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95{\%} Confidence Interval [CI] 5.6-42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95{\%} CI 2.8-8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95{\%} CI 1.1-2.8; P = .01). Conclusions: DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.",
keywords = "Delirium, Delirium-superimposed dementia, Dementia, Elderly, Institutionalization, Mobility, Mortality",
author = "Alessandro Morandi and Daniel Davis and Fick, {Donna M.} and Renato Turco and Malaz Boustani and Elena Lucchi and Fabio Guerini and Sara Morghen and Tiziana Torpilliesi and Simona Gentile and MacLullich, {Alasdair M.} and Marco Trabucchi and Giuseppe Bellelli",
year = "2014",
doi = "10.1016/j.jamda.2013.12.084",
language = "English",
volume = "15",
pages = "349--354",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients

AU - Morandi, Alessandro

AU - Davis, Daniel

AU - Fick, Donna M.

AU - Turco, Renato

AU - Boustani, Malaz

AU - Lucchi, Elena

AU - Guerini, Fabio

AU - Morghen, Sara

AU - Torpilliesi, Tiziana

AU - Gentile, Simona

AU - MacLullich, Alasdair M.

AU - Trabucchi, Marco

AU - Bellelli, Giuseppe

PY - 2014

Y1 - 2014

N2 - Objective: Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation. Design: Prospective cohort study. Setting: Hospital rehabilitation unit. Participants: A total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006. Measurements: Dementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations. Results: The median age was 77 years (interquartile range: 71-83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95% Confidence Interval [CI] 5.6-42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8-8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1-2.8; P = .01). Conclusions: DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.

AB - Objective: Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation. Design: Prospective cohort study. Setting: Hospital rehabilitation unit. Participants: A total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006. Measurements: Dementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations. Results: The median age was 77 years (interquartile range: 71-83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95% Confidence Interval [CI] 5.6-42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8-8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1-2.8; P = .01). Conclusions: DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.

KW - Delirium

KW - Delirium-superimposed dementia

KW - Dementia

KW - Elderly

KW - Institutionalization

KW - Mobility

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=84899641610&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899641610&partnerID=8YFLogxK

U2 - 10.1016/j.jamda.2013.12.084

DO - 10.1016/j.jamda.2013.12.084

M3 - Article

VL - 15

SP - 349

EP - 354

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 5

ER -