International Psychogeriatrics



An 18-month prospective cohort study of functional outcome of delirium in elderly patients: activities of daily living


Stephen Vida a1a3c1, Guillaume Galbaud du Fort a1a2a3a4, Ritsuko Kakuma a2a4, Louise Arsenault a3, Robert W. Platt a4a5 and Christina M. Wolfson a2a4
a1 Division of Geriatric Psychiatry, McGill University Health Centre, Montreal, Canada
a2 Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
a3 Department of Psychiatry, McGill University, Montreal, Canada
a4 Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
a5 Department of Pediatrics, McGill University, Montreal, Canada

Article author query
vida s   [PubMed][Google Scholar] 
galbaud du fort g   [PubMed][Google Scholar] 
kakuma r   [PubMed][Google Scholar] 
arsenault l   [PubMed][Google Scholar] 
platt rw   [PubMed][Google Scholar] 
wolfson cm   [PubMed][Google Scholar] 

Abstract

Objectives: To examine delirium, chronic medical problems and sociodemographic factors as predictors of activities of daily living (ADL), basic ADL (BADL) and instrumental ADL (IADL).

Methods: A prospective cohort study of four groups of elderly patients examined in the emergency department (ED): those with delirium, dementia, neither, and both. All were aged 66 years or older and living at home. Delirium was assessed with the Confusion Assessment Method and dementia with the Informant Questionnaire on Cognitive Decline in the Elderly. Demographic variables and chronic medical problems were ascertained with questionnaires. Outcome was ADL at 6, 12 and 18 months, measured with the ADL subscale of the Older Americans Resources and Services instrument.

Results: Univariate analyses suggested significantly poorer ADL, particularly IADL, at 18 months in the delirium versus the non-delirium group, in the absence of dementia only. Statistically significant independent predictors of poorer ADL at 18 months in the non-dementia groups were poorer initial ADL, stroke, Parkinson's disease, hypertension and female sex. Independent predictors of poorer BADL at 18 months in the non-dementia groups were poorer initial BADL, Parkinson's disease, stroke, cancer, colds/sinusitis/laryngitis, female sex and hypertension. Independent predictors of poorer IADL at 18 months in the non-dementia groups were poorer initial IADL, stroke, never-married status, colds/sinusitis/laryngitis, arthritis and hypertension, with Parkinson's disease showing a non-significant but numerically large regression coefficient.

Conclusion: Rather than finding delirium to be a predictor of poorer functional outcome among survivors, we found an interaction between delirium and dementia and several plausible confounders, primarily chronic medical problems, although we cannot rule out the effect of misclassification or survivor bias.

(Received March 10 2005)
(returned for revision April 12 2005)
(revised version received December 13 2005)
(Accepted December 14 2005)
(Published Online April 26 2006)


Key Words: delirium; outcome; activities of daily living.

Correspondence:
c1 Correspondence should be addressed to: Stephen Vida, McGill University Health Centre, Allan Memorial Pavilion, P2.062-1025 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada. Phone: +514-934-1934, ext. 34539; Fax: +514-843-1431. Email: stephen.vida@muhc.mcgill.ca.


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