Delirium among older adults in rural long-term care: Falls, hospitalizations, and 12-month mortality outcomes.

摘要

Delirium is a serious and distressing phenomenon in older adults that can result in poorer functional outcomes and higher mortality. In addition, other negative outcomes in patients experiencing a delirium event, such as falls, mortality, and hospitalizations, may occur in the long-term care setting. This study used data from the Delirium in Rural Long-Term Care study and mortality data from the National Death Index (NDI) to examine falls, hospitalization, and mortality among 320 subjects. Subjects were grouped into non-cases, subsyndromal delirium, hypoactive delirium, hyperactive delirium, and mixed delirium based upon scoring using the Confusion Assessment Method (CAM) NEECHAM Scale, Mini-Mental State Exam (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Vigilance A instruments. Falls and hospitalizations were analyzed at 2 time intervals: a 28-day surveillance period and a 12-month follow-up period, with data suggesting underreporting of fall events. The results showed delirium cases to be older and with lower Functional Independence Measure (FIM) composite scores. Subsyndromal delirium cases had lower medication patterns than non-cases and hypoactive subtype had higher medication usage than subsyndromal types. While mortality and hospitalization rates were not significant, patterns suggest that certain interventions and increased nursing surveillance might be useful in the 12-month period following delirium.