Hospital delirium a ‘red flag’ for severe health decline

A single episode of delirium—a state of confusion and agitation—in hospitalized older adults is a significant risk factor for other serious health complications including fractures, stroke and sepsis, a University of Queensland study has found. Delirium is often triggered by infection, surgery, pain, dehydration or medication, which affects up to 1 in 4 older adults during a hospital stay. However, many of its long-term health impacts have not been fully understood.

In a large-scale study published in The Lancet Healthy Longevity, Dr. David Ward from UQ’s Center for Health Services Research said researchers analyzed data from nearly 30,000 patients in the UK Biobank and hospital records over a period of up to 26 years to assess the long-term clinical consequences of in-hospital delirium.

“We found delirium was associated with a higher risk of 12 adverse outcomes, independent of frailty and pre-existing dementia, which shows it is a warning of longer-term vulnerability,” said Dr. Ward. “An episode of delirium in hospital doubled the risk of falls and urinary incontinence, and there was a 50% to 70% increased risk of pneumonia, fecal incontinence, fractures, stroke, hip fracture, sepsis, acute kidney injury, and pressure injury.

“There was also a 20% to 30% higher risk of gastrointestinal bleeding and heart failure. These are very strong associations that highlight delirium as a red flag for multisystem vulnerability, and we hope these findings will help guide follow-up care and prevention strategies.”

Dr. Ward said research showed up to half of all delirium cases that develop in hospital could be prevented through better care practices.

Lead author Dr. Markus Haapanen from the University of Helsinki, who undertook a fellowship at UQ for this study, said episodes of delirium were often thought of as a short-lived complication, but the study showed a persistently elevated risk of adverse health outcomes even after the episode subsides.

“Identifying and managing delirium while patients are in hospital is often the focus of care, but these results suggest a need to extend treatment and care after a patient is discharged,” Dr. Haapanen said. “Delirium prevention, treatments and structured follow-up for patients recovering from delirium represent opportunities for improving care and outcomes beyond hospitalization.

“This research also opens the door for future studies to measure longer-term health outcomes following a delirium episode.”