Elderly hospital patients with delirium more likely to die within a year

By Laura Kennedy

Hospital patients over 65 who are referred for a psychiatric consultation and found to have delirium are more likely than those without delirium to die within one year following diagnosis, according to a new study published in the journal General Hospital Psychiatry.

“Clinical physicians should pay close attention to delirious ,” says lead author Jian-An Su, M.D., a psychiatrist at Chang Gung Memorial in Taiwan. “Early psychiatric consultation could decrease mortality.”

is a sudden change in mental status associated with physical illness and related medications. A delirious patient may experience bouts of confusion, lethargy, agitation, or hallucinations alternating with periods of lucidity.

The new study is based on records for more than 600 patients over 65 years of age examined by psychiatrists in a Taiwanese hospital between 2002 and 2006. Of these, 172 were diagnosed with delirium. The researchers later reviewed state records to find out how many of the patients had subsequently died. The findings were compared to those for a similar group of patients who had not experienced delirium.

Elderly inpatients who were diagnosed with delirium had significantly higher death rates than other patients in the first year after delirium onset, found the authors. The results held regardless of patients’ gender, physical illnesses, or treatment with antipsychotic medications.

In the elderly, delirium is often characterized by “quiet” symptoms, such as confusion and lethargy. “These patients are frequently overlooked, under-diagnosed, or misdiagnosed as having depression, dementia, or severe illness,” note the authors.

“Primary physicians -- whether intensivists, hospitalists, surgical teams, or others -- must first be attuned to a patient’s behavior and cognitions in order to request a psychiatric consultation for a complete evaluation,” says Ian Cook, M.D., of the Resnick Neuropsychiatric Hospital at the University of California, Los Angeles.

Cook suggests that a brief series of questions such as, “Can you tell me the name of where we are? What day is it? Why are you here in the hospital?” could help attending physicians recognize patients with delirium more consistently, along with observing behaviors such as agitation or excessive sleepiness. Many resources on delirium also advise family members to alert providers immediately if their loved one displays sudden changes in mental status while in the hospital.

More information: Tsai, M-C. et al. Three-year mortality of delirium among elderly inpatients in consultation–liaison service. General Hospital Psychiatry In Press.

add to favorites email to friend print save as pdf

Related Stories

Delirium following cardiac surgery common in older patients

May 18, 2011

Delirium following cardiac surgery, a serious postoperative complication, is fairly common in older patients, affecting more than one-third of patients over 70 according to research to be presented at the American Psychiatric ...

Relief on the way for delirium patients

May 27, 2011

Adults with dementia and delirium may soon have a way to combat their delirium, thanks to a $2.4 million, five-year grant from the National Institutes of Health.

Study: delirium presentation predicts mortality

Jul 06, 2009

The way certain patients present in the post-acute hospital setting with delirium, a common, preventable but life-threatening acute confusional state, predicts mortality, according to a study conducted by the Institute for ...

Recommended for you

The hunt for botanicals

Dec 19, 2014

Herbal medicine can be a double-edged sword and should be more rigorously investigated for both its beneficial and harmful effects, say researchers writing in a special supplement of Science.

Mozambique decriminalises abortion to stem maternal deaths

Dec 19, 2014

Mozambique has passed a law permitting women to terminate unwanted pregnancies under specified conditions, a move hailed by activists in a country where clandestine abortions account for a large number of maternal deaths.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.