Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Faheem, W. et al. (2023) Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study. European Geriatric Medicine, 14(2), pp. 325-332. (doi: 10.1007/s41999-022-00737-y) (PMID:36696045) (PMCID:PMC10113325)

Abstract

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Drozdowska, Bogna and Burton, Dr Jenni and Elliott, Emma and Quinn, Professor Terry and Taylor-Rowan, Dr Martin
• Authors: Faheem, W., Nandra, T., Richardson, S., Saliu, D., Wilson, D., Jackson, T. A., Magill, L., McCluskey, L., Perry, R., Welch, C., Wilson, D., Copeland, C., Cunningham, E. L., Davis, D., Treml, J., Pinkney, T., Quinn, T., Nightingale, P., Jelley, B., Gaunt, V., Lochlainn, M. N., Giridharan, K., Alsahab, M., Makin, S., Torsney, K., Masoli, J., Ronan, L., Burton, J. K., Todd, O., Taylor, J., Willott, R., Cox, N., Healy, R., Haddad, N., Ramakrishna, S., Subhan, Z., Mazzoleni, A., Nynaes, O., Crofts, J., McNicholas, E., Robinson, H. J., Thyn, T., Baillie, J., McKeown, W., Rice, C., Sloan, G. W., Williamson, K., Hayat, Y., Lim, V. H., Millichamp, K., Bazaraa, A., Chilton, A., Harbinson, A., Headlam, J., Hunter, E., Hussain, Z., Mahmood, A. W., Ng, L., Sundara, S., Tan, F., Wheeler, A., Wright, S., Baldwin, J. B. G., O’shea, K., Hodhody, G., Mayor, K., Patel, R., Bhakta, S., Goujon, M., Jakupaj, A., Dove, J., Kearney, M., McCormack, V., Moore, K., Pope, L., Shah, H.-A., Shaw, M. E., Smith, G. M., Love, R., Mukundan, M., Shahid, M., Alareed, A., Beharry, K., Bhat, G., Bremakumar, S., Caines, L., Darko, S., Rai, N., De Mucha, P. V., Adams, P., McDonald, H., Mills, S., Parry, F., Rickard, F., Winearls, S., Farah, R., Grange, R., Herbert, F., Lonsdale-Eccles, E., Ain, Q. U., Watson, H., Bultynck, C., Cavaliere, C., Doherty, C., Evans, S., Furmedge, D., MacCuish, A. H., Hindley, E., Meyer, C., Mullarkey, E., Pullen, R., Ryan, A., Sarma, D., Seymour, E., Stambollouian, K., Thayabaran, D., Wu, C., Peck, G., Raza, M., Sahnan, K., Dhillon, A., Abiola, O. O., Bryant, C., Bygate, R., Frewen, J., Greaves, I., Morrow, O., Tetlow, S., Tinson, G., Yunus, A., Bedi, S., Evans, O., Giet, L., Behbahani, A., Bhattacharya, S., Hunt, C., Mishra, R., Connor, L., Poynton, J., Deacon, E., Durcan, R., Fisken, E., Hall, S. A., Noble, J., Prendergast, E. L., Macharouthu, A., Macrae, V., Murphy-Ackroyd, E., Rose, E. C., Watt, N., Blair, M., Mackenzie, E. R., McCormack, R., Irwin, S. J., Einarsson, A., Khor, M., Alhadadi, B., Cameron, E., Campbell, A., Capek, E., Christie, L., Connell, L., Cook, A., Deosaran, J., Elliott, M., Evans, E., Fancourt, S., Henderson, S., Hussain, A., Jones, K., Kelly, D., McErlean, C. M., Miller, H., Naeem, F., Ostrowski, C., Parkinson, M., Sami, F., Shepherd, A., Whyte, L., Wright, E., Ferguson, E. E. C., Gallagher, M., McCluskey, H. J., Beveridge, L., Clements, H. A., Hart, J., Henderson, N., Lim, S. K., Lucocq, J. E., McCulloch, A., Murray, A. A., Ngan, E. E. Y., Traill, P. K., Walter, A., Wilson, M. S. J., Wrathall, A., Yap, Z. J., Anderson, C., Abu-Arafeh, H., Gluck, I., Mitchell, O., Robson, R., Sampson, E. L., Annamalai, A., Bhatti, J., Briggs, L., Fraser, D., Gui, J., Leah, E., Matthews, N. R., Mithrakumar, P., Moad, M., Sen, M., Straughan, J., Taranu, R., Usmani, K., Aamir, A., Achara, A., Akintade, O., Ellis, E. J., Gurung, S., Iwu, C., Khalid, A. B., Koshedo, S., Nagumantry, S., Nashed, N., Nwabufor, P., Obi, I. T., Visvaratnam, P., Wu, E., Bertagne, M., Jackson, P., Allen, J., Brown, H., Champion, J., Christodoulides, N., Handley, O., Macdonald, F. E., Beeley, L. J., Clayton, V., Kay, A., Marshall, J., Morgan, H., Naish, G., Cleaver, S. L., Evans, J., Morrow, A., Amarnani, R., Cheah, K. L., Cushen, C., Enfield-Bance, A., Glasser, M., Govindji, S., Mani, S., Gregory, J., Jatti, P., Khan, A., Lee, H., Millner, H., Naqvi, H., Williamson, E., Harkin, T., Khizar, B., Lewis, A., Pendleton, H., Rutter, S., Ahmed, R., Coffey, F., Hackett, B., Holmes, E. A. M., Khan, A., Mustafa, Z., Bowman, M. A., Irvine, J., Patterson, K., Horner, S., Wong, T. W., Cairns, C., Foster, K., Hornsby, A., Horton, R., Jones, L., King, R., Lyon, E., Tencheva, A., Wilson, F., Young, L. J., Dama, S., Giblin, E., Kunaselan, L., Lowes, O., Menezes, R., Taylor, A., Timperley, A., Batho, R., Bell, C., Carter, S., Croft, P., Griffiths, E., Hall, G., Hunt, W., Jacques, H., Leishman, F., Murthy, S., Quinn, S., Reidm, J., Walker, A., Matthews, S. A., Behbahani, A., Glasser, M., Ferreira, A. S., Ashton, C., Byravan, S., Cummings, L., Faruq, S., Jagdeo, S., Thomas, P., Broadhurst, K., Wilson, J. B., Bowden, H., Hoffman, K., Jones, H. T., Katz-Summercorn, C., Khambay, E., Porter, L., Speed, J., Austin, K., Bahsoon, F., Laud, R., Ali, J., Fergusson, N., Wilkes, C., Babb, L., Gaywood, J., Green, J., Kantczak, A., Madden, K. F., Porter-Bent, S., San, M. S. S., Babar, L., Chamberlain, H., Cricklow, T., Giles, A., Gupta, A., Hughes, C., Lee, T., Cheema, A., Matheswaran, Y., Nneamaka, A., Ross, A., Vedutla, T., Allain, T. J., Bowen, E., Dovey, J., Gaskell, N., Scott, D., Stratton, E., Thake, M., Bullock, S., McKay, S., Radoja, S., Abdelbadiee, S., Cohen, S., Giddings, J., Miller, C. J., Mumtaz, E., Patel, M. D., Prasad, V., Satharasinghe, L., Studley, M., Browne, M., Durrant, S. K., Jay, E., McQuillan, A., Offer, M., Varghese, J., Baron, A., Chourot, C., Jackson, P., Kirrane, K., Rayner, H., Tantam, K., Tumi, E., Venkat, S., Aggarwal, N., Astaire, E., Basker, K., Berwick, L., Bilton, E., Chamboult, A.-L., Chapman, G., Chevolleau, J., Fenneley, G., House, S., Ingamells, N., Jewell, E., Kalyaani, V., Kiani, M., Konda, N., Kumar, A., Lai, J., Large, J., Livesey, J., Majid, Z., McCready, J., Moorey, H., Morgan, B., Morrison, K., Mosley, A., Pailing, A., Pettler, S., Rashid, S., Rimmer, L., Scarlett, D., Sehmbi, G., Smith, A., Smith, N., Sprosen, C., Taylor, E., Taylor, J., Tse, C., Turton, S., Vardon, H., Virk, J., Warwicker, S., Woodman, H., Woodward, B. L., Wynne, L., Yule, O., Ahmad, A., Appiah-Odame, P., Barlow, C., Kuek, D. K. C., Nicholls, I., Norman, E., Pyc, W., Vasudev, A., Adams, L. A. T., Box, E., Chai, C. S., Wilson, D. S., Drozdowska, B., Elliott, E., Stirling, A., Taylor-Rowan, M., Webb, H., Wong, L., Abras, A., Adam, M., Amin, Z., Cooper, O., Davies, R., Ikhwan, W. I. C., Layton, G. R., Mohammedseid-Nurhussien, A., Shakeel, S., Waraich, H., Ahmed, J., Ball, K., Debrah, K., Page, V., Bei, Z. X., McCauley, H., McShane, D., Cooper, F., Grundmann, N., Haley, M., Le Poideven, A., McClelland, S. B., Moore, E., Pang, N., Currie, H., Davies-Morris, J., Edwards, S., Janagal, S., Jenkin, R., Jones, P., Kumbun, G., Parry, S., Tyagi, B., Valentine, J., Abdullah, S., Abu, E., Ahmad, S., Ahmed, B., Ahmed, H., Andrusca, A., Ansell, M., Arkle, T., Bargaoanu, I., Chuter, C., Houldershaw, K., Ibanichuka, J., Iqbal, S., Kabia, A., Kadir, I., Krishan, A., McClean, A., McGonigal, G., Mishra, P., Ofoche, G., Reay, A., Stapley, S. M., Swietoslawski, A., Syed, N., Velusamy, K., Wahballa, A., and Wilcockson, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: European Geriatric Medicine
• Publisher: Springer
• ISSN: 1878-7649
• ISSN (Online): 1878-7657
• Published Online: 25 January 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in European Geriatric Medicine 14(2):325-332
• Publisher Policy: Reproduced under a Creative Commons licence