Outcomes in complex patients with delirium and subsyndromal delirium one year after hospital discharge

Abstract

There has been an increasing interest in delirium as a clinical syndrome in elderly patients in the last years (de Rooij et al., 2005). Until now the diagnosis has been dichotomous, but recent studies appear to show that a further categorization of this syndrome may lead to a higher diagnostic and prognostic value. The subsyndromal delirium (SSD) displays some of the symptoms without developing the full syndrome and it is intermediate in severity between non-delirious controls and full syndromal delirium, although it has no officially recognized diagnostic criteria (Levkoff et al., 1996). There is growing evidence about the prognostic significance of SSD among elderly individuals, but to date there are very few published studies on SSD in elderly patients. The goal of our study was to corroborate one-year outcomes after discharge. With this aim we performed a prospective multicenter study in March 2011 that recruited patients aged 75 years and older admitted to the acute geriatric wards of three tertiary hospitals in Spain – Complejo Hospitalario de Navarra, Hospital Universitario de Getafe, and Hospital Marqués de Valdecilla – at the same time during a 48-hour period, and were then followed up for one year. Four geriatricians were responsible for the patients’ screening and enrollment. A thorough geriatric assessment included clinical and demographic information (age, sex, education level, living arrangements before admission, presence of visual and hearing impairment) and comorbidity with the Cumulative Illness Rating Scale-Geriatric (CIRS-G). The CIRS-G rates 13 body systems on a five-point severity scale and is reliable because it allows all comorbid diseases from clinical examinations and medical files to be taken into account in a comprehensive manner.