Incidence of delirium in an acute geriatric community hospital: an exploratory analysis of an observational cohort study controlled with a meta-analysis of incidences from literature.

Abstract

Background Delirium in hospitalised older adults is associated with negative health outcomes. Admission to an alternative care setting may lower the incidence of delirium. The Acute Geriatric Community Hospital (AGCH) was recently opened in the Netherlands and uses a multi-component non-pharmacological intervention strategy to prevent delirium. Objective To describe the incidence of delirium found in the AGCH and compare this incidence to a hospital control group found in literature. Design Prospective cohort study; exploratory meta-analysis of proportions. Setting The AGCH is an acute geriatric unit in an intermediate care facility. Participants Patients aged >65 years with acute medical conditions admitted to the AGCH. Methods Delirium assessment using the Confusion Assessment Method (CAM) upon admission and on day one, two and three or until delirium had resolved. Patients charts were reviewed if CAM was missing. In an logistic mixed-effects model, the delirium incidence rate in AGCH was compared to pooled delirium incidence rates from six studies found in a high-quality review. Results 214 patients from the AGCH (mean age 81.9 years, 47% male, 12% with a history of dementia) were included in the analysis. Delirium developed in 8% (18/214) (95% CI [confidence interval] 5-13%) of patients during AGCH admission compared to 16% (95% CI 12-21%) in hospitals. Admission to the AGCH was associated with a decreased delirium incidence rate compared to the hospital control group (OR [odds ratio]= 0.49, 95% CI 0.24-0.98, p-value=0.044). Conclusions The delirium incidence in the AGCH was relatively low compared to those incidences found in general hospitals.