BACKGROUND: Delirium is common among hospitalized elders and may persist for months. The adverse impact of delirium on independence may increasingly occur in the postacute care (PAC) setting. The purpose of this study is to examine the association between delirium resolution and functional recovery in skilled nursing facilities specializing in PAC. METHODS: Patients were screened for delirium on admission after an acute hospitalization at PAC facilities. Only patients with "Confusion Assessment Method"-defined delirium were enrolled. Delirium and activities of daily living were assessed prehospital, at PAC admission, and at four (2-week, and 1-, 3-, and 6-month) follow-up assessments to measure functional ability. Four distinct delirium resolution groups were created ranging from resolution within 2 weeks without recurrence to no resolution over 6 months. Repeated-measures analysis of covariance was used to determine if functional performance differed over time by delirium resolution status. RESULTS: Among the 393 PAC patients, functional recovery differed significantly (p <.0001) by delirium resolution status. Patients who resolved their delirium by 2 weeks without recurrence regained 100% of their prehospital functional level, whereas patients who never resolved their delirium retained less than 50% of their prehospital functional level. Patients with slower resolving delirium and recurrent delirium had intermediate functional outcomes. CONCLUSIONS: Resolution of delirium among PAC patients appears to be a prerequisite for functional recovery. Delirium resolution within 2 weeks without recurrence is associated with excellent functional recovery. Effective strategies to resolve delirium promptly and prevent its recurrence in the PAC setting will likely benefit patient rehabilitation and functional recovery.
BACKGROUND:Delirium is common among hospitalized elders and may persist for months. The adverse impact of delirium on independence may increasingly occur in the postacute care (PAC) setting. The purpose of this study is to examine the association between delirium resolution and functional recovery in skilled nursing facilities specializing in PAC. METHODS:Patients were screened for delirium on admission after an acute hospitalization at PAC facilities. Only patients with "Confusion Assessment Method"-defined delirium were enrolled. Delirium and activities of daily living were assessed prehospital, at PAC admission, and at four (2-week, and 1-, 3-, and 6-month) follow-up assessments to measure functional ability. Four distinct delirium resolution groups were created ranging from resolution within 2 weeks without recurrence to no resolution over 6 months. Repeated-measures analysis of covariance was used to determine if functional performance differed over time by delirium resolution status. RESULTS: Among the 393 PAC patients, functional recovery differed significantly (p <.0001) by delirium resolution status. Patients who resolved their delirium by 2 weeks without recurrence regained 100% of their prehospital functional level, whereas patients who never resolved their delirium retained less than 50% of their prehospital functional level. Patients with slower resolving delirium and recurrent delirium had intermediate functional outcomes. CONCLUSIONS: Resolution of delirium among PAC patients appears to be a prerequisite for functional recovery. Delirium resolution within 2 weeks without recurrence is associated with excellent functional recovery. Effective strategies to resolve delirium promptly and prevent its recurrence in the PAC setting will likely benefit patient rehabilitation and functional recovery.
Authors: Sarinnapha M Vasunilashorn; Long Ngo; Sharon K Inouye; Towia A Libermann; Richard N Jones; David C Alsop; Jamey Guess; Sandra Jastrzebski; Janet E McElhaney; George A Kuchel; Edward R Marcantonio Journal: J Gerontol A Biol Sci Med Sci Date: 2015-07-27 Impact factor: 6.053
Authors: Lori A Daiello; Annie M Racine; Ray Yun Gou; Edward R Marcantonio; Zhongcong Xie; Lisa J Kunze; Kamen V Vlassakov; Sharon K Inouye; Richard N Jones; David Alsop; Thomas Travison; Steven Arnold; Zara Cooper; Bradford Dickerson; Tamara Fong; Eran Metzger; Alvaro Pascual-Leone; Eva M Schmitt; Mouhsin Shafi; Michele Cavallari; Weiying Dai; Simon T Dillon; Janet McElhaney; Charles Guttmann; Tammy Hshieh; George Kuchel; Towia Libermann; Long Ngo; Daniel Press; Jane Saczynski; Sarinnapha Vasunilashorn; Margaret O'Connor; Eyal Kimchi; Jason Strauss; Bonnie Wong; Michael Belkin; Douglas Ayres; Mark Callery; Frank Pomposelli; John Wright; Marc Schermerhorn; Tatiana Abrantes; Asha Albuquerque; Sylvie Bertrand; Amanda Brown; Amy Callahan; Madeline D'Aquila; Sarah Dowal; Meaghan Fox; Jacqueline Gallagher; Rebecca Anna Gersten; Ariel Hodara; Ben Helfand; Jennifer Inloes; Jennifer Kettell; Aleksandra Kuczmarska; Jacqueline Nee; Emese Nemeth; Lisa Ochsner; Kerry Palihnich; Katelyn Parisi; Margaret Puelle; Sarah Rastegar; Margaret Vella; Guoquan Xu; Margaret Bryan; Jamey Guess; Dee Enghorn; Alden Gross; Yun Gou; Daniel Habtemariam; Ilean Isaza; Cyrus Kosar; Christopher Rockett; Douglas Tommet; Ted Gruen; Meg Ross; Katherine Tasker; James Gee; Ann Kolanowski; Margaret Pisani; Sophia de Rooij; Selwyn Rogers; Stephanie Studenski; Yaakov Stern; Anthony Whittemore; Gary Gottlieb; John Orav; Reisa Sperling Journal: Anesthesiology Date: 2019-09 Impact factor: 7.892
Authors: Dan K Kiely; Edward R Marcantonio; Sharon K Inouye; Michele L Shaffer; Margaret A Bergmann; Frances M Yang; Michael A Fearing; Richard N Jones Journal: J Am Geriatr Soc Date: 2009-01 Impact factor: 5.562