Regular Research Articles
Geriatric Ward Hospitalization Reduced Incidence Delirium Among Older Medical Inpatients

https://doi.org/10.1097/JGP.0b013e3181a315d5Get rights and content

Objectives:

Most strategies for delirium prevention in older hospitalized patients are common good clinical geriatric care. We investigated whether acute geriatric ward (AGW) hospitalization, compared with acute general medical ward (AGMW) hospitalization, is associated with reduced incident delirium in older medical inpatients.

Design:

prospective observational study.

Setting:

a tertiary care, university hospital in Torino.

Participants:

consecutive medical patients 70 years or older admitted from the emergency department to an AGW and to an AGMW were included.

Measurements:

Baseline measures included demography, functional and psychocognitive status, comorbidity, physiological and clinical severity of acute illness. Incident delirium was evaluated by qualified psychiatrists according to the Confusion Assessment Method and the Delirium Rating Scale.

Results:

Delirium occurred in 8 of 121 patients admitted to AGW (6.6%) and in 20 of 131 patients admitted to AGMW (15.2%). After adjustment for significant differences in baseline covariates between groups, AGW hospitalization remained independently associated with less incident delirium (relative risk 0.90, 95% confidence interval: 0.024-0.331, p <0.001). In a multivariable logistic model with delirium incidence as independent variable, AGW hospitalization was independently associated with lower delirium incidence (relative risk 0.039, 95% confidence interval: 0.007-0.214, p <0.001), whereas greater cognitive impairment (p <0.001), higher Acute Physiology and Chronic Health Evaluation II score (p = 0.001) and recent stressful events (p = 0.001) were associated with increased delirium incidence.

Conclusion:

AGW hospitalization is associated with less incident delirium among older medical inpatients. Despite inherent limitations of observational studies, these hypothesis-generating findings add to previous evidence of potential benefit in delirium prevention from geriatric consultation in several hospital settings.

Section snippets

Study Population, Setting, and Data Collection

The study was conducted within a University teaching hospital (San Giovanni Battista, Turin, northern Italy), with consecutive subjects aged 70 years and older, admitted from the emergency department to an AGMW or to an AGW. In this hospital there are eight internal medicine units, including seven AGMWs and one AGW; admissions to medicine units are independently decided by emergency department physicians and there is no compelling indication for selective admission to specific internal medicine

RESULTS

Of the 338 patients evaluated at admission to the acute wards, 64 were excluded (5 for delirium at entry; 12 for history of psychiatric disorder or alcohol abuse; 17 for primary diagnosis of stroke; 5 for coma or aphasia; 21 for absence of caregiver at entry; 4 for language barrier). Informed consent was not obtained for 13 patients and 9 patients were not included for missing or incomplete data. Therefore, 252 patients (mean age 82.4 ± 4.1 year, 53% women; 121 admitted to AGW and 131 admitted

DISCUSSION

Results of the present study suggest that among older medical inpatients AGW hospitalization is independently associated with less incident delirium, compared with AGMW admission. Although these results do not allow to draw definite conclusions and should better be regarded as exploratory and hypothesis-generating findings, nevertheless they were consistent across both statistical methods used; indeed, AGW hospitalization seemed to be independently protective either when conventional

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