Abstract

Introduction: Delirium is a common acute neuropsychiatric syndrome in older adults and is associated with poor outcomes. There is limited evidence on outcomes among older patients admitted to medical assessment units (MAUs) compared to those without delirium.

Objective: To examine the association between delirium and mortality, hospital length of stay, and readmission rates in patients aged ≥65 years admitted to an MAU.

Methods: A retrospective observational cohort study was conducted at Ysbyty Ystrad Fawr Hospital, Wales. Hospital records for patients aged ≥65 years admitted to the MAU during 2023 were reviewed. The primary outcomes were length of stay (LOS), inpatient mortality, 30-day mortality, 90-day mortality, and 30-day readmission. Patients were categorised into delirium and non-delirium groups based on documented 4AT screening results and clinical notes.

Results: Of 200 patients included, 100 had delirium and 100 did not. The delirium group had a significantly longer LOS (26.3 vs 10.7 days, p=0.007) and higher inpatient mortality (18% vs 2%, p=0.002). Thirty-day mortality (23.0% vs 7.0%, p=0.0015) and 90-day mortality (35.0% vs 11.0%, p<0.0001) were also significantly higher in the delirium group. No significant difference was observed in 30-day readmissions (15.0% vs 20.0%, p=NS). Sub-analysis showed 32% patients were living with companion. It was observed those living with a companion had a lower rate of delirium (23%) as compared to those living alone (41%, p<0.0015).

Conclusion: Delirium was associated with poorer clinical outcomes among older patients acutely admitted to the MAU. The observed association between companionship and lower rate of delirium warrants further investigation in larger, prospective studies.

Keywords

dementia, clinical outcomes, mortality, hospital, older people