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Delirium on Hospital Admission in Aged Hip Fracture Patients

Prediction of Mortality and 2-Year Functional Outcomes

^a Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore
^b School of Social Work and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
^c Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York

Melissa M. Dolan, who is now at the National Opinion Research Center at the University of Chicago, 55 East Monroe, Suite 1800, Chicago, IL 60603 E-mail: dolan-melissa{at}norcmail.uchicago.edu.

William B. Ershler, MD

Background. Hip fracture patients are at increased risk of confusion or delirium due to the trauma associated with the injury and the rapid progression to hospitalization and surgery, in addition to the pain and loss of function experienced. Hip fracture patients who develop delirium may require longer hospital stays, are more often discharged to long-term care, and have a generally poor prognosis for returning home or regaining function in activities of daily living (ADL).

Methods. The present study examines the impact of delirium present on hospital admission in a sample of 682 nondemented, aged hip fracture patients residing in the community at the time of their fracture. In-hospital assessments designed to assess both prefracture and postfracture functioning, as well as follow-up interviews at 2, 6, 12, 18, and 24 months postfracture, were obtained from participants.

Results. Analyses indicate that baseline or admission delirium is an important prognostic predictor of poor long-term outcomes in persons without known cognitive impairment, after controlling for age, gender, race, comorbidity, and functional status. Delirium at admission (i.e., prior to surgery) was associated with poorer functioning in physical, cognitive, and affective domains at 6 months postfracture and slower rates of recovery. Impairment and delays in recovery may be further exacerbated by increased depressive symptoms in confused patients over time. Delirium on hospital admission was not a significant predictor of mortality after adjustment for confounding factors.

Conclusions. The present findings further emphasize the significance of immediate detection and treatment of delirium in hip fracture patients to ameliorate the short and long-term effects of acute confusion on functional outcomes.

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