International Psychogeriatrics

Research Article

Affective functioning after delirium in elderly hip fracture patients

Chantal J. Slora1 c1, Joost Witloxa1, René W. M. M. Jansena1, Dimitrios Adamisa2, David J. Meaghera3, Esther Tiekena1, Alexander P. J. Houdijka4, Willem A. van Goola5, Piet Eikelenbooma5 and Jos F. M. de Jonghea1

a1 Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands

a2 Research and Academic Institute of Athens, Athens, Greece

a3 Department of Adult Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland

a4 Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands

a5 Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands

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.

(Received July 13 2012)

(Reviewed September 07 2012)

(Revised October 20 2012)

(Accepted October 23 2012)

(Online publication November 30 2012)

Key words:

  • delirium;
  • hip fracture;
  • affect;
  • neuropsychiatry;
  • anxiety;
  • PTSD;
  • depression

Correspondence:

c1 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.

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