Delirium can add a sudden layer of agitation and functional difficulty to dementia during an acute hospital stay. In a study of patients admitted to acute geriatric units, delirium superimposed on dementia was associated with poorer function and more in-hospital falls than dementia alone.
Delirium adds problems on top of dementia
A study of patients in acute geriatric units found delirium superimposed on dementia in 39.8% of the patients with dementia. Compared with dementia alone, the combination was associated with higher agitation scores, poorer functional status and more frequent falls in the hospital. The reported fall rates were 29.9% for patients with delirium superimposed on dementia and 17.5% for those with dementia alone, according to the Psychogeriatrics study.
These findings describe a more difficult hospital course when delirium occurs alongside dementia. The study reports associations, so the figures do not establish that delirium alone caused the differences. They do show why clinicians and families may need to recognize a change in agitation or function as consequential during an admission.
The hospital stay can shape what comes next
The consequences may extend beyond the hospital. In a study of older adults with and without pre-existing dementia, hospital-recorded delirium was associated with whether and when a person entered nursing home care. The association was present regardless of whether the person already had dementia. The Age and Ageing authors suggest that preventing delirium could potentially delay or avert some transitions to nursing home care.
That finding does not mean every person with dementia who develops delirium will move to a nursing home. It connects delirium recorded during a hospital stay with a later care transition across the older adults studied, including those with dementia.
A missed record can leave an important event unclear
Delirium may not be clearly recorded at discharge. In an observational study of acutely admitted older patients, only 4 of 50 patients with delirium, or 8%, had delirium documented in the discharge summary. The current admission was a readmission for 42% of patients with delirium, compared with 18% of those without delirium.
This study was not limited to people with dementia, so those figures should not be read as dementia-specific rates. They do point to a practical issue for care after discharge: a serious change during the hospital stay may be absent from the written summary that follows the patient.
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
How common was delirium among patients with dementia in acute geriatric units?
In the Psychogeriatrics study of patients admitted to acute geriatric units, delirium superimposed on dementia occurred in 680 patients, or 39.8% of the patients with dementia. That rate applies to the population in that study.
Was delirium usually listed in discharge paperwork?
In the study of acutely admitted older patients, only 8% of patients with delirium had the diagnosis documented in their discharge summary. The study population was older adults admitted to hospital, not only people with dementia.
Did the nursing home transition finding apply only to people with dementia?
No. The Age and Ageing study found an association between hospital-recorded delirium and whether and when older adults entered nursing home care, regardless of pre-existing dementia.
Sources
- Agitation Severity and Psychotropic Prescription in Acute Patients With Delirium Superimposed on Dementia (Psychogeriatrics)
- Delirium and incident nursing home admission among people with and without dementia (Age and Ageing)
- Delirium prevalence and incidence in acutely admitted older patients: an observational cohort study (BMC Geriatrics)
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