Rebecca Mitchell1, Lara Harvey2, Henry Brodaty3, Brian Draper3, Jacqueline Close4. 1. Australian Institute of Health Innovation, Macquarie University, NSW, Australia; Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, NSW, Australia. Electronic address: r.mitchell@mq.edu.au. 2. Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, NSW, Australia. 3. Dementia Collaborative Research Centre - Assessment and Better Care, UNSW, NSW, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW, NSW, Australia. 4. Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, NSW, Australia; Prince of Wales Clinical School, UNSW, NSW, Australia.
Abstract
BACKGROUND: Delirium is common in older hip fracture patients, yet its association with mortality after hip fracture remains uncertain. This study aimed to determine whether delirium was associated with all-cause one-year mortality after hip fracture in older patients and whether the effect of delirium was independent of dementia status. METHOD: A retrospective analysis of linked hospitalisation and mortality data for patients aged ≥65 years with a hip fracture during 1 January 2010 to 30 June 2014 in New South Wales, Australia. The association between delirium and mortality after a hip fracture was assessed using Cox proportional hazard regression. RESULTS: There were 4,065 (14.6%) of 27,888 hip fracture hospitalisations identified with delirium during hospitalisation. Individuals with delirium had a higher age-adjusted rate of all-cause one-year mortality after hip fracture compared to individuals without delirium (35.3% versus 23.9%). After adjusting for covariates, the risk of all-cause mortality was increased at one-year post-admission for older individuals compared to those aged 65-69 years, for individuals with multiple comorbidities, dementia (Hazard Ratio (HR): 1.14; 95%CI:1.08-1.20), delirium (HR: 1.19; 95%CI:1.12-1.26), and who had an Intensive Care Unit admission (HR: 1.44; 95%CI:1.31-1.59). Comorbid delirium did not add additional mortality risk for individuals with a hip fracture who have dementia. CONCLUSIONS: Delirium identified in hospital was associated with all-cause one-year mortality after hip fracture in older Australians without dementia. As delirium is potentially preventable, better systematic assessment and documentation of a hip fracture patient's cognitive state is warranted to select the most effective strategies to prevent and manage delirium.
BACKGROUND:Delirium is common in older hip fracturepatients, yet its association with mortality after hip fracture remains uncertain. This study aimed to determine whether delirium was associated with all-cause one-year mortality after hip fracture in older patients and whether the effect of delirium was independent of dementia status. METHOD: A retrospective analysis of linked hospitalisation and mortality data for patients aged ≥65 years with a hip fracture during 1 January 2010 to 30 June 2014 in New South Wales, Australia. The association between delirium and mortality after a hip fracture was assessed using Cox proportional hazard regression. RESULTS: There were 4,065 (14.6%) of 27,888 hip fracture hospitalisations identified with delirium during hospitalisation. Individuals with delirium had a higher age-adjusted rate of all-cause one-year mortality after hip fracture compared to individuals without delirium (35.3% versus 23.9%). After adjusting for covariates, the risk of all-cause mortality was increased at one-year post-admission for older individuals compared to those aged 65-69 years, for individuals with multiple comorbidities, dementia (Hazard Ratio (HR): 1.14; 95%CI:1.08-1.20), delirium (HR: 1.19; 95%CI:1.12-1.26), and who had an Intensive Care Unit admission (HR: 1.44; 95%CI:1.31-1.59). Comorbid delirium did not add additional mortality risk for individuals with a hip fracture who have dementia. CONCLUSIONS:Delirium identified in hospital was associated with all-cause one-year mortality after hip fracture in older Australians without dementia. As delirium is potentially preventable, better systematic assessment and documentation of a hip fracturepatient's cognitive state is warranted to select the most effective strategies to prevent and manage delirium.
Authors: Lauren J Hunt; R Sean Morrison; Siqi Gan; Edie Espejo; Katherine A Ornstein; W John Boscardin; Alexander K Smith Journal: J Am Geriatr Soc Date: 2022-02-05 Impact factor: 7.538
Authors: Bheeshma Ravi; Daniel Pincus; Stephen Choi; Richard Jenkinson; David N Wasserstein; Donald A Redelmeier Journal: JAMA Netw Open Date: 2019-02-01