Age and Ageing Advance Access originally published online on April 28, 2006
Age and Ageing 2006 35(4):350-364; doi:10.1093/ageing/afl005
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Systematic Review |
Occurrence and outcome of delirium in medical in-patients: a systematic literature review
Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds LS2 9LT, UK
Address correspondence to: N. Siddiqi. Tel: (+44) 113 343 2740. Email: n.siddiqi{at}leeds.ac.uk
Background: Despite the acknowledged clinical importance of delirium, research evidence for measures to improve its management is sparse. A necessary first step to devising appropriate strategies is to understand how common it is and what its outcomes are in any particular setting.
Objective: To determine the occurrence of delirium and its outcomes in medical in-patients, through a systematic review of the literature.
Method: We searched electronic medical databases, the Consultation-Liaison Literature Database and reference lists and bibliographies for potentially relevant studies. Studies were selected, quality assessed and data extracted according to preset protocols.
Results: Results for the occurrence of delirium in medical in-patients were available for 42 cohorts. Prevalence of delirium at admission ranged from 10 to 31%, incidence of new delirium per admission ranged from 3 to 29% and occurrence rate per admission varied between 11 and 42%. Results for outcomes were available for 19 study cohorts. Delirium was associated with increased mortality at discharge and at 12 months, increased length of hospital stay (LOS) and institutionalisation. A significant proportion of patients had persistent symptoms of delirium at discharge and at 6 and 12 months.
Conclusion: Delirium is common in medical in-patients and has serious adverse effects on mortality, functional outcomes, LOS and institutionalisation. The development of appropriate strategies to improve its management should be a clinical and research priority. As delirium prevalent at hospital admission is a significant problem, research is also needed into preventative measures that could be applied in community settings.
Keywords: delirium, systematic review, prevalence, incidence, prognosis, elderly
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