Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-28T00:34:27.428Z Has data issue: false hasContentIssue false

Affective functioning after delirium in elderly hip fracture patients

Published online by Cambridge University Press:  30 November 2012

Chantal J. Slor*
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Joost Witlox
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
René W. M. M. Jansen
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Dimitrios Adamis
Affiliation:
Research and Academic Institute of Athens, Athens, Greece
David J. Meagher
Affiliation:
Department of Adult Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland
Esther Tieken
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Alexander P. J. Houdijk
Affiliation:
Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands
Willem A. van Gool
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
Piet Eikelenboom
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
Jos F. M. de Jonghe
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
*
Correspondence should be addressed to: Chantal J. Slor, MSc, Department of Geriatric Medicine, Medical Center Alkmaar, PO Box 501, 1800 AM Alkmaar, the Netherlands. Phone: +31-72-5484068; Fax: +31-72-5482197. Email: c.slor@mca.nl.

Abstract

Background: Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied.

Methods: For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge.

Results: Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups.

Conclusion: This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.

Trial name: The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient. URL: http://clinicaltrials.gov/ct2/show/NCT00497978?term=taurine+hip+fracture&rank=1. Registration number: NCT00497978.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adamis, D., Treloar, A., Martin, F. C. and Macdonald, A. J. (2007). A brief review of the history of delirium as a mental disorder. History of Psychiatry, 18, 459469.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
American Society of Anesthesiologists (1963). ASA Physical Status Classification System. Available at: http://www.asahq.org/Home/For-Members/Clinical-Information/ASA-Physical-Status-Classification-System; last accessed 1995.Google Scholar
Basinski, J. R., Alfano, C. M., Katon, W. J., Syrjala, K. L. and Fann, J. R. (2010). Impact of delirium on distress, health-related quality of life, and cognition 6 months and 1 year after hematopoietic cell transplant. Biology of Blood and Marrow Transplantation, 16, 824831.CrossRefGoogle ScholarPubMed
Blank, K. and Perry, S. (1984). Relationship of psychological processes during delirium to outcome. American Journal of Psychiatry, 141, 843847.Google ScholarPubMed
Brodaty, H., Altendorf, A., Withall, A. and Sachdev, P. (2010). Do people become more apathetic as they grow older? A longitudinal study in healthy individuals. International Psychogeriatrics, 22, 426436.CrossRefGoogle Scholar
Burns, A.et al. (2007). Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials. Journal of the American Geriatrics Society, 55, 7580.CrossRefGoogle ScholarPubMed
Cerejeira, J., Nogueria, V., Luis, P., Vaz-Serra, A. and Mukaetova-Ladinska, E. B. (2012). The cholinergic system and inflammation: common pathways in delirium pathophysiology. Journal of the American Geriatrics Society, 60, 669675.CrossRefGoogle ScholarPubMed
Cole, M. G. (2010). Persistent delirium in older hospital patients. Current Opinion in Psychiatry, 23, 250254.CrossRefGoogle ScholarPubMed
Cunningham, C. (2011). Systemic inflammation and delirium: important co-factors in the progression of delirium. Biochemical Society Transactions, 39, 945953.CrossRefGoogle Scholar
Davydow, D. S. (2009). Symptoms of depression and anxiety after delirium. Psychosomatics, 50, 309316.CrossRefGoogle ScholarPubMed
de Jonghe, J. F., Schmand, B., Ooms, M. E. and Ribbe, M. W. (1997). Abbreviated form of the Informant Questionnaire on cognitive decline in the elderly. Tijdschrift voor Gerontologie en Geriatrie, 28, 224229.Google ScholarPubMed
Dolan, M. M.et al. (2000). Delirium on hospital admission in aged hip fracture patients: prediction of mortality and two-year functional outcomes. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55A, 527534.CrossRefGoogle Scholar
Fann, J. R., Alfano, C. M., Roth-Roemer, S., Katon, W. J. and Syrjala, K. L. (2007). Impact of delirium on cognition, distress, and health-related quality of life after hematopoietic stem-cell transplantation. Journal of Clinical Oncology, 25, 12231231.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle Scholar
Girard, T. D.et al. (2007). Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Critical Care, 11, R28.CrossRefGoogle ScholarPubMed
Greene, N. H., Attix, D. K., Weldon, B. C., Smith, P. J., McDonagh, D. L. and Monk, T. G. (2009). Measures of executive function and depression identify patients at risk for postoperative delirium. Anesthesiology, 110, 788795.CrossRefGoogle ScholarPubMed
Hetherington, R. (1954). The Snellen chart as a test of visual acuity. Psychologische Forschung, 24, 349357.CrossRefGoogle ScholarPubMed
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941948.CrossRefGoogle Scholar
Inouye, S. K., Viscoli, C. M., Horwitz, R. I., Hurst, L. D. and Tinetti, M. E. (1993). A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Annals of Internal Medicine, 119, 474481.CrossRefGoogle ScholarPubMed
Jones, C., Griffiths, R. D., Humphris, G. and Skirrow, P. M. (2001). Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine, 29, 573580.CrossRefGoogle ScholarPubMed
Jorm, A. F. and Jacomb, P. A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychological Medicine, 19, 10151022.CrossRefGoogle ScholarPubMed
Kalisvaart, K. J.et al. (2005). Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. Journal of the American Geriatrics Society, 53, 16581666.CrossRefGoogle ScholarPubMed
Knaus, W. A., Draper, E. A., Wagner, D. P. and Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical Care Medicine, 13, 818829.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.CrossRefGoogle ScholarPubMed
Lenze, E. J.et al. (2004). Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. International Journal of Geriatric Psychiatry, 19, 472478.CrossRefGoogle ScholarPubMed
Lenze, E. J.et al. (2007). Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. Journal of the American Geriatrics Society, 55, 8186.CrossRefGoogle ScholarPubMed
Lindeboom, J. and Matto, D. (1994). Digit series and Knox cubes as concentration tests for elderly subjects. Tijdschrift voor Gerontologie en Geriatrie, 25, 6368.Google ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 6165.Google ScholarPubMed
Marcantonio, E. R.et al. (2005). Outcomes of older people admitted to postacute facilities with delirium. Journal of the American Geriatrics Society, 53, 963969.CrossRefGoogle ScholarPubMed
Matheny, M. E.et al. (2011). Inflammatory cytokine levels and depressive symptoms in older women in the year after hip fracture: findings from the Baltimore Hip studies. Journal of the American Geriatrics Society, 59, 22492255.CrossRefGoogle ScholarPubMed
Nickel, M.et al. (2004). The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. Journal of Intensive Care Medicine, 19, 285290.CrossRefGoogle ScholarPubMed
O'Connor, J. C.et al. (2009). Lipopolyssacharide-induced depressive-like behavior is mediated by indoleamine 2,3-dioxygenase activation in mice. Molecular Psychiatry, 14, 511522.CrossRefGoogle Scholar
Olofsson, B., Lundström, M., Borssén, B., Nyberg, L. and Gustafson, Y. (2005). Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures. Scandinavian Journal of Caring Sciences, 19, 119127.CrossRefGoogle ScholarPubMed
Pattanayak, R. D. and Sagar, R. (2011). Depression in dementia patients: issues and challenges for a physician. Journal of the Association of Physicians of India, 59, 650652.Google ScholarPubMed
Richter, J. C., Waydhas, C. and Pajonk, F. G. (2006). Incidence of posttraumatic stress disorder after prolonged surgical intensive care unit treatment. Psychosomatics, 47, 223230.CrossRefGoogle ScholarPubMed
Sheehan, D. V.et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 2233.Google ScholarPubMed
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric depression scale (GDS): recent findings and development of a shorter version. Clinical Gerontologist, 37, 819820.Google Scholar
Stoll, C.et al. (1999). Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Medicine, 25, 697704.CrossRefGoogle ScholarPubMed
Trzepacz, P. T., Mittal, D., Torres, R., Kanary, K., Norton, J. and Jimerson, N. (2001). Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. The Journal of Neuropsychiatry & Clinical Neurosciences, 13, 229242.CrossRefGoogle ScholarPubMed
van Gool, W. A., van de Beek, D. and Eikelenboom, P. (2010). Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet, 375, 773775.CrossRefGoogle ScholarPubMed
van Munster, B. C., Korevaar, J. C., Zwinderman, A. H., Levi, M., Wiersinga, W. J. and de Rooij, S. E. (2008). Time-course of cytokines during delirium in elderly patients with hip fractures. Journal of the American Geriatrics Society, 56, 17041709.CrossRefGoogle ScholarPubMed
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. The Journal of the American Medical Association, 304, 443451.CrossRefGoogle ScholarPubMed
Witlox, J.et al. (2011). Cerebrospinal fluid β-amyloid and tau are not associated with risk of delirium: a prospective cohort study in older adults with hip fracture. Journal of the American Geriatrics Society, 59, 12601267.CrossRefGoogle Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361370.CrossRefGoogle ScholarPubMed