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Association Between Delirium Resolution and Functional Recovery Among Newly Admitted Postacute Facility Patients

¹ Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
² Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
³ Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
⁴ Interdisciplinary Center on Aging, Harvard Medical School, Boston, Massachusetts.

Address correspondence to Dan K. Kiely, MPH, MA, Hebrew Rehabilitation Center for Aged, Research and Training Institute, 1200 Centre Street, Boston, MA 02131. E-mail: kiely{at}mail.hrca.harvard.edu

Background. Delirium is common among hospitalized elders and may persist for months. The adverse impact of delirium on independence may increasingly occur in the postacute care (PAC) setting. The purpose of this study is to examine the association between delirium resolution and functional recovery in skilled nursing facilities specializing in PAC.

Methods. Patients were screened for delirium on admission after an acute hospitalization at PAC facilities. Only patients with "Confusion Assessment Method"-defined delirium were enrolled. Delirium and activities of daily living were assessed prehospital, at PAC admission, and at four (2-week, and 1-, 3-, and 6-month) follow-up assessments to measure functional ability. Four distinct delirium resolution groups were created ranging from resolution within 2 weeks without recurrence to no resolution over 6 months. Repeated-measures analysis of covariance was used to determine if functional performance differed over time by delirium resolution status.

Results. Among the 393 PAC patients, functional recovery differed significantly (p <.0001) by delirium resolution status. Patients who resolved their delirium by 2 weeks without recurrence regained 100% of their prehospital functional level, whereas patients who never resolved their delirium retained less than 50% of their prehospital functional level. Patients with slower resolving delirium and recurrent delirium had intermediate functional outcomes.

Conclusions. Resolution of delirium among PAC patients appears to be a prerequisite for functional recovery. Delirium resolution within 2 weeks without recurrence is associated with excellent functional recovery. Effective strategies to resolve delirium promptly and prevent its recurrence in the PAC setting will likely benefit patient rehabilitation and functional recovery.