Hospital patients with dementia and other causes of confusion have longer stays and worse treatment outcomes than people without the condition, UK research has confirmed.
It is the first large population-based study to prove that people with confusion caused by dementia or delirium, have inferior treatment outcomes compared with other patients.
“People who are admitted to hospital with confusion seem to do badly”
The study, carried out by the University of Stirling, the University of Dundee and NHS Fife, examined outcomes in more than 10,000 patients aged 65 or older, with an emergency medical admission.
Researchers found that patients with “cognitive spectrum disorder” (CSD) – defined as delirium or dementia – stayed in hospital for an average of 25 days on average – more than double the length of stay for those without it, who remained for 11.8 days.
Patients with CSD were also more likely to have died within a year of admission – with a 40% mortality rate, compared with a 26% rate in the rest of the hospital population, according to the study published in the journal BMC Medicine.
Overall, 16.7% of older people admitted during the study had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% had unspecified cognitive impairment. Of those with known dementia, 45.8% had delirium superimposed.
“There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest length of stay, and people with dementia the worst mortality at one year,” said the study authors.
Lead researcher, Professor Emma Reynish, chair in dementia studies at Stirling, said: “People with confusion – or cognitive spectrum disorders – make up over one-third of the population over 65 who are admitted as an emergency to hospital, and half of patients over the age of 85 years.
Hospital patients with confusion ‘have worse outcomes’
Professor Reynish highlighted that delirium was the most common form of CSD in hospital patients, at 24.6%, followed by known dementia, at 17.3%.
“People who are admitted to hospital with confusion seem to do badly, and are at an increased risk of dying, increased risk of re-admission, and a hospital stay nearly two weeks longer than those without confusion,” she said.
“It is unclear whether this is as a result of the care that they are given or the disease process itself, or a combination of both,” she noted.
But Professor Reynish argued that concentrating hospital treatment and care on just those with dementia or delirium alone “may be detrimental to the rest of the hospital population who are confused”.
“The hospital care pathway should be re-examined and designed to centre around those with ‘confusion’ or cognitive spectrum disorders, rather than dementia or delirium alone,” she said.
She also said more research was needed to determine direct causal relationships – for example, whether outcomes were affected by the underlying pathological processes of the disease or the care delivered.
As reported in January by Nursing Times, UK researchers also recently concluded that older patients who experienced delirium in hospital may subsequently be at greater risk of developing dementia.
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The researchers, from University College London and Cambridge University, said their study was the first to show the multiplying effects of delirium and dementia in older patients.