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Delirium, frailty and mortality: interactions in a prospective study of hospitalized older people

Dani, M; Owen, L; Jackson, TA; Rockwood, K; Sampson, E; Davis, DHJ; (2018) Delirium, frailty and mortality: interactions in a prospective study of hospitalized older people. The Journals of Gerontology: Series A , 73 (3) pp. 415-418. 10.1093/gerona/glx214. Green open access

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Abstract

BACKGROUND: It is unknown if the association between delirium and mortality is consistent for individuals across the whole range of health states. A bimodal relationship has been proposed, where delirium is particularly adverse for those with underlying frailty, but may have a smaller effect (perhaps even protective) if it is an early indicator of acute illness in fitter people. We investigated the impact of delirium on mortality in a cohort simultaneously evaluated for frailty. METHODS: We undertook an exploratory analysis of a cohort of consecutive acute medical admissions aged ≥70. Delirium on admission was ascertained by psychiatrists. A Frailty Index (FI) was derived according to a standard approach. Deaths were notified from linked national mortality statistics. Cox regression was used to estimate associations between delirium, frailty and their interactions on mortality. RESULTS: The sample consisted of 710 individuals. Both delirium and frailty were independently associated with increased mortality rates (delirium: HR 2.4, 95%CI 1.8–3.3, p<0.01; frailty (per SD): HR 3.5, 95%CI 1.2–9.9, p=0.02). Estimating the effect of delirium in tertiles of FI, mortality was greatest in the lowest tertile: tertile 1 HR 3.4 (95%CI 2.1–5.6); tertile 2 HR 2.7 (95%CI 1.5–4.6); tertile 3 HR 1.9 (95% CI 1.2–3.0). CONCLUSION: While delirium and frailty contribute to mortality, the overall impact of delirium on admission appears to be greater at lower levels of frailty. In contrast to the hypothesis that there is a bimodal distribution for mortality, delirium appears to be particularly adverse when precipitated in fitter individuals.

Type: Article
Title: Delirium, frailty and mortality: interactions in a prospective study of hospitalized older people
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/gerona/glx214
Publisher version: http://dx.doi.org/10.1093/gerona/glx214
Language: English
Additional information: Copyright © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: delirium, frailty, mortality, elderly, cox proportional hazards models, psychiatrist
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > MRC Unit for Lifelong Hlth and Ageing
URI: https://discovery.ucl.ac.uk/id/eprint/10028184
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