Abstract
Background
Delirium is underdiagnosed in seniors at emergency departments (EDs) even though it
is a frequent complication and is associated with functional and cognitive decline.
As frailty is an independent predictor of adverse events in seniors, screening for
frailty in EDs may help identify those at risk of delirium.
Objectives
To assess if screening older patients for frailty in EDs could help identify those
at risk of delirium.
Methodology
This study was part of the multicenter prospective cohort INDEED study. Patients aged ≥ 65 years, initially free of delirium, with an ED stay ≥ 8 h
were followed up to 24 h after ward admission. Frailty was assessed at baseline using
the Clinical Frailty Scale; seniors with a score ≥ 5/7 were considered frail. Their
delirium status was assessed twice daily using the Confusion Assessment Method.
Results
Among the 335 included patients, delirium occurred in 20/70 frail (28.6%) patients
and in 20/265 (7.6%) robust ones. After adjusting for age and sex, the risk of delirium
during ED stay was 3.13 (95% confidence interval 1.60–6.21) times higher in frail
than in robust patients. Time between arrival to the ED and the incidence of delirium
was also shorter for frail patients than for the robust ones (adjusted hazard ratio
2.44, 95% confidence interval 1.26–4.74).
Conclusion
Increased frailty is associated with increased delirium during ED stays. Screening
for frailty at emergency triage could help ED professionals identify seniors at higher
risk of delirium.
Keywords
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Article info
Publication history
Published online: May 12, 2018
Accepted:
February 22,
2018
Received in revised form:
January 31,
2018
Received:
September 11,
2017
Footnotes
This study was funded by the Fonds de Recherche en Santé du Québec (FQRS 29307).
ME had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He was responsible for the design, funding, and conduct of the study. VB managed the study and data collection. MG wrote the manuscript. MG, EM, and MJS were involved in the statistical analysis, and data interpretation. RD, EG, MP, and ME were responsible for recruitment at all four sites. MJS, VB, RD, EG, MP, SB, PV, and ME reviewed and approved the manuscript.
The authors declare no conflict of interest.
Identification
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© 2018 Elsevier Inc. All rights reserved.
