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LETTER TO THE EDITOR |
,
,
Rehabilitation and Aged Care Unit * "Ancelle della Carità" Hospital, Cremona
Geriatric Research Group, Brescia
University Tor Vergata, Rome
Address correspondence to Giuseppe Bellelli, MD, Rehabilitation and Aged Care Unit, "Ancelle della Carità" Hospital, via Aselli 14, 26100 Cremona, Italy, or Geriatric Research Group, via Romanino 1, 25125 Brescia, Italy. E-mail: giuseppebellelli{at}libero.it or bellelli-giuseppe{at}ancelle.it
To the Editor:
In their article recently published in the Journal, Kiely and colleagues (1) showed that the three psychomotor activities (hypoactive, hyperactive, or mixed) of delirium had an elevated 1-year risk of death in comparison with a normal psychomotor group, with the hypoactive group having the highest mortality risk. We want to contribute to this topic with our own data, referring to a population of 1864 patients (aged 65 years or older) consecutively discharged from our Rehabilitation and Aged Care Unit (RACU) between January 1, 2003, and January 31, 2006, and followed at 12 months. The diagnosis of delirium was made by two experienced geriatricians (G.B. and S.S.) using the Confusion Assessment Method (2), and the level of agitation/sedation was assessed by nursing staff three times daily using the Richmond Agitation and Sedation scale (RASS) (3). Delirium was categorized as hyperactive, hypoactive, and mixed type according to clinical judgment and RASS score. Delirium was detected in 229 (12.3%) individuals. Of these, 103 (45.0%) developed hypoactive delirium, 45 (19.7%) hyperactive delirium, and 81 (35.4%) mixed delirium. Patients in the three groups were similar concerning clinical characteristics, except for the albumin serum levels, which were lowest in the hypoactive group (2.8 ± 0.4 gr/dl vs 2.9 ± 0.5 gr/dl in the mixed and 3.0 ± 0.4 gr/dl in the hyperactive groups, p =.03 on Bonferroni post hoc analysis). Although not significant, the individuals with hypoactive delirium had also a lower Body Mass Index (BMI) score (BMI = 22.6 ± 4.5 in the hypoactive group, 22.9 ± 4.5 in the mixed group, 23.3 ± 4.3 in the hyperactive group; p =.72) and greater comorbidity (Charlson Index = 3.5 ± 2.1 in the hypoactive group, 3.4 ± 2.0 in the mixed group, 2.8 ± 1.8 in the hyperactive group; p =.14) in comparison to those with mixed and hyperactive subtypes. Figure 1 shows the Kaplan-Meier survival curves for the three delirium subtypes and the no-delirium group. The individuals with hypoactive delirium had the highest mortality rate, followed by the mixed group, then the hyperactive group, in decreasing order. The Cox proportional hazard analysis, after adjustment for covariates and confounders (age, gender, Charlson Index, albumin serum levels and preadmission Barthel Index score), revealed that the hypoactive group was 1.71 (95% confidence interval [CI], 1.07–2.75) times more likely to die during the 1-year follow-up relative to the individuals without delirium.
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References
This article has been cited by other articles:
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  T. T. Hshieh, T. G. Fong, E. R. Marcantonio, and S. K. Inouye Cholinergic Deficiency Hypothesis in Delirium: A Synthesis of Current Evidence J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2008; 63(7): 764 - 772. [Abstract] [Full Text] [PDF]
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