Association between frailty and delirium in older adult patients discharged from hospital

Henk Verloo, Céline Goulet, Diane Morin, Armin von Gunten, Henk Verloo, Céline Goulet, Diane Morin, Armin von Gunten

Abstract

Background: Delirium and frailty - both potentially reversible geriatric syndromes - are seldom studied together, although they often occur jointly in older patients discharged from hospitals. This study aimed to explore the relationship between delirium and frailty in older adults discharged from hospitals.

Methods: Of the 221 patients aged >65 years, who were invited to participate, only 114 gave their consent to participate in this study. Delirium was assessed using the confusion assessment method, in which patients were classified dichotomously as delirious or nondelirious according to its algorithm. Frailty was assessed using the Edmonton Frailty Scale, which classifies patients dichotomously as frail or nonfrail. In addition to the sociodemographic characteristics, covariates such as scores from the Mini-Mental State Examination, Instrumental Activities of Daily Living scale, and Cumulative Illness Rating Scale for Geriatrics and details regarding polymedication were collected. A multidimensional linear regression model was used for analysis.

Results: Almost 20% of participants had delirium (n=22), and 76.3% were classified as frail (n=87); 31.5% of the variance in the delirium score was explained by frailty (R (2)=0.315). Age; polymedication; scores of the Confusion Assessment Method (CAM), instrumental activities of daily living, and Cumulative Illness Rating Scale for Geriatrics; and frailty increased the predictability of the variance of delirium by 32% to 64% (R (2)=0.64).

Conclusion: Frailty is strongly related to delirium in older patients after discharge from the hospital.

Keywords: Edmonton Frailty Scale; cognitive impairment; delirium risk factors; physical impairment.

Figures

Figure 1
Figure 1
Recruitment of the participants.

References

    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington DC: American Psychiatric Publishing; 2013.
    1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–922.
    1. Holroyd-Leduc JM, Khandwala F, Sink KM. How can delirium best be prevented and managed in older patients in hospital? CMAJ. 2010;182(5):465–470.
    1. Holt R, Young J, Heseltine D. Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age Ageing. 2013;42(6):721–727.
    1. Teale EA, Young JR. Multicomponent delirium prevention interventions: not as effective as NICE suggest? Age and Ageing. 2015;44(6):915–917.
    1. McAvay GJ, Van Ness PH, Bogardus ST, Jr, et al. Older adults discharged from the hospital with delirium: 1-year outcomes. J Am Geriatr Soc. 2006;54(8):1245–1250.
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–762.
    1. Santangelo A, Testai M, Maugeri D. Delirium is marker of frailty? Study in a population over 90-year old recovered in a Sicilian RSA. Eur Psychiatry. 2010;25:588.
    1. Quinlan N, Marcantonio ER, Inouye SK, Gill TM, Kamholz B, Rudolph JL. Vulnerability: the crossroads of frailty and delirium. J Am Geriatr Soc. 2011;59(suppl 2):S262–S268.
    1. Abellan Van Kan G, Vellas B. Is the mini nutritional assessment an appropriate tool to assess frailty in older adults? J Nutr Health Aging. 2011;15(3):159–161.
    1. Buurman BM, Hoogerduijn JG, van Gemert EA, de Haan RJ, Schuurmans MJ, de Rooij SE. Clinical characteristics and outcomes of hospitalized older patients with distinct risk profiles for functional decline: a prospective cohort study. PLoS One. 2012;7(1):e29621.
    1. Clegg A, Young J. The frailty syndrome. Clin Med. 2011;11(1):72–75.
    1. Leung JM, Tsai TL, Sands LP. Brief report: preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg. 2011;112(5):1199–1201.
    1. Pol RA, van Leeuwen BL, Visser L, Izaks GJ, van den Dungen JJAM, Tielliu IFJ. Standardised frailty indicator as predictor for postoperative delirium after vascular surgery: a prospective cohort study. Eur J Vasc Endovasc Surg. 2011;42(6):824–830.
    1. Leung JM, Tsai TL, Sands LP. Preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg. 2011;112(5):1199–1201.
    1. Verloo H, Goulet C, Morin D, von Gunten A. Effect estimation of an innovative nursing intervention to improve delirium among home-dwelling older adults: a randomized controlled pilot trial. Dement Geriatr Cogn Dis Extra. 2015;5(1):176–190.
    1. 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(3):189–198.
    1. Laplante J, Cole MG, McCusker J, Singh S, Ouimet MA. Confusion assessment method. Validation of a French-language version. Perspect Infirm. 2005;3(1):12–20.
    1. Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc. 2008;56(5):823–830.
    1. Hair JKJ, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis: A Global Perspective. 7th ed. Boston: Pearson Education Inc; 2010.
    1. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;6:526–529.
    1. de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JSM, Olde Rikkert MGM, Nijhuis-van der Sanden MWG. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–114.
    1. Podsiadlo D, Richardson S. The timed up & go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–148.
    1. Derouesné C, Poitreneau J, Hugonot L, Kalafat M, Dubois B, Laurent B. Le mini-mental state examination (MMSE): un outil pratique pour l’évaluation de l’état cognitif des patients par le clinicien, version française consensuelle. [Mini mental state Exam: a practical tool for clinicians to assess the cognitive state of patients, French consensual version] La Presse Médicale. 1999;28(21):1141–1148. French.
    1. Naugle RI, Kawczak K. Limitations of the mini-mental state examination. Cleve Clin J Med. 1989;56(3):277–281.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–186.
    1. Buurman BM, van Munster BC, Korevaar JC, de Haan RJ, de Rooij SE. Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review. J Clin Epidemiol. 2011;64(6):619–627.
    1. Barberger-Gateau P, Commenges D, Gagnon M, Letenneur L, Sauvel C, Dartigues JF. Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers. J Am Geriatr Soc. 1992;40(11):1129–1134.
    1. Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41(3):237–248.
    1. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 6th ed. Boston: Pearson Education Inc; 2013.
    1. IBM-SPSS . Statistical Package for Social Sciences. Somer, NY: IBM Corporation; 2011.
    1. Cohen J. Statistical Power and Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NY: Lawrence ERdbaum Associates; 1988.
    1. Mason CH, Perreault WD., Jr Collinearity, power, and interpretation of multiple regression analysis. J Market Res. 1991;28(3):268–280.
    1. Eeles EMP, Peel NM, White SV, O’Mahony MS, Bayer AJ, Bhat R. Frailty and illness severity in relation to delirium in older inpatients. Australas J Ageing. 2013;32:28.
    1. Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1.
    1. Hoogerduijn JG, Buurman BM, Korevaar JC, Grobbee DE, de Rooij SE, Schuurmans MJ. The prediction of functional decline in older hospitalised patients. Age Ageing. 2012;41(3):381–387.
    1. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “she was probably able to ambulate, but I’m not sure”. J Am Med Assoc. 2011;306(11):1782–1793.
    1. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. J Am Med Assoc. 2010;304(4):443–451.
    1. Cameron I, Fairhall N, Gill L, Lockwood K, Langron C, Aggar C. Developing interventions of frailty. Adv Geriatr. 2015;2015:845356.
    1. Clegg A, Westby M, Young JB. Under-reporting of delirium in the NHS. Age Ageing. 2011;40(2):283–286.
    1. Eeles EMP, White SV, O’Mahony SM, Bayer AJ, Hubbard RE. The impact of frailty and delirium on mortality in older inpatients. Age Ageing. 2012;41(3):412–416.
    1. Andrew MK. Le capital social et la santé des personnes âgées. [Social capital and healthy aging] Retraite et Société. 2005;46:132–145. French.
    1. Agostini JV, Zhang Y, Inouye SK. Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. J Am Geriatr Soc. 2007;55(1):43–48.
    1. Bergman H, Ferrucci L, Guralnik JM, Hogan DB, Hummel S, Karunananthan S. Frailty: an emerging research and clinical paradigm – issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62(7):731–737.
    1. Oo MT, Tencheva A, Khalid N, Chan YP, Ho SF. Assessing frailty in the acute medical admission of elderly patients. J R Coll Physicians Edinb. 2013;43(4):301–308.
    1. Turner G, Clegg A. Best practice guidelines for the management of frailty: a British Geriatrics Society, age UK and Royal College of General Practitioners report. Age Ageing. 2014;43(6):744–747.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–M156.

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