Delirium in a sample of elderly inpatients: factors associated with the occurrence of delirium and mortality within a period of one year after the episode of delirium

Abstract

Global companies have gone through a transition process in the age structure, characterized mainly by the aging population. In Brazil, during the past two decades, life expectancy increased by 7.6 years and older now represent 10.8% of the population in 2012. This process raised the incidence of several diseases, including dementia. In Brazil, due to the increase of the morbidities related to aging, this population group accounts for 28.5% of hospital expenses of the Unified Health System (SUS), approximately 3 billion in 2010 and projected to 41.9% (6 billion) in 2030. The term "delirium" derives from the Latin "delirare" which literally means "out of place".As DSM-5, "delirium" is characterized as a disorder of attention and consciousness developed in a short period of time with periodic fluctuation, which evidence indicates be consequent to other medical conditions such as substance intoxication or its withdrawn, toxin exposure or multiple etiologias¹¹. According to the literature, the "delirium" and dementia have a common pathogenetic mechanism cholinergic dysfunction, which maintains a close relationship to their occurrence in the same individual. According to Witlox (2010), there is evidence that "delirium" in elderly patients is associated with an increased risk of dementia, regardless of age, gender, or severity of comorbid conditions associated with the episode of "delirium".Elderly patients admitted to general hospitals with an episode of "delirium" find it difficult to diagnosis and treatment as a result of professional unpreparedness and the environment, and these factors influence prognosis. According to Bellelli (2015), the prevalence of delirium is 15%, however, only 1% receives diagnosis cotreatment.¹u The occurrence of "delirium" in hospitalized patients is correlated with mortality. Main goal: Check the occurrence of death in patients seen in the geriatric ward in a period of 1 year after hospitalization related to the episode of "delirium" secondary.Objetivo: Check retrospectively which variables were associated with the occurrence of "delirium" in elderly patients admitted to the geriatric ward of a hospital public tertiary school for a period of 12 months. Methods: A cross-sectional study with the analysis of bank data of 91 elderly patients admitted in the ward of the Geriatric Discipline, Botucatu Medical School - UNESP. The sample refers to patients referred from the emergency room to the hospital according to availability. In the analyzed period all hospitalized (socio-demographic and clinical data) were assessed, with no inclusion or exclusion criteria. Patients were evaluated by a medical residency program in geriatric residents and that the cases were all checked by the teacher of discipline. Para the diagnosis of "delirium", the criteria used were the "Confusion Assessment Method" (CAM). For the diagnosis of dementia, we used the criteria recommended by the Brazilian Academy of Neurology. Other diagnoses were made in accordance with the statistical criteria varied. Analysis: Categorical variables are described in Gross and relative values were and were compared using the chi-square test. Continuous variables are presented as a measure of central tendency (mean and median, as they have normal distribution or not). A comparison of continuous variables will be performed using the Student t-test (if they have normal distribution / parametric) or the Mann-Whitney test (if non-parametric distribution).