Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study
Waleed Faheem, Taran Nandra, Sarah Richardson, David Saliu, Daisy Wilson, Thomas Jackson, Laura Magill, Lauren McCluskey, Rita Perry, Carly Welch, Daisy Wilson, Claire Copeland, Emma Cunningham, Daniel Davis, Jonathan Treml, Thomas Pinkney, Terence J. Quinn, Peter Nightingale, Benjamin Jelley, Victoria Gaunt, Mary Ní Lochlainn, Kumudhini Giridharan, Mustafa Alsahab, Stephen Makin, Kelli Torsney, Jane Masoli, Lindsay Ronan, Jennifer Kirsty Burton, Oliver Todd, Joanne Taylor, Ruth Willott, Natalie Cox, Róisín Healy, Nedaa Haddad, Sharan Ramakrishna, Zahid Subhan, Antonella Mazzoleni, Olga Nynaes, Jodie Crofts, Emily McNicholas, Hannah Jayne Robinson, Thyn Thyn, Jonathan Baillie, William McKeown, Caroline Rice, Gerrard W. Sloan, Katherine Williamson, Yasmeen Hayat, Vee Han Lim, Katie Millichamp, Amr Bazaraa, Angharad Chilton, Alexander Harbinson, John Headlam, Elisabeth Hunter, Zainab Hussain, Al Wakkass Mahmood, Liji Ng, Srividya Sundara, Felicia Tan, Alice Wheeler, Sophie Wright, Jack B. G. Baldwin, Kate O’shea, Ghazal Hodhody, Kara Mayor, Riana Patel, Shiv Bhakta, Marie Goujon, Adriana Jakupaj, James Dove, Matthew D. Kearney, Vincent McCormack, Kirsty Moore, Leo Pope, Hussun-Ara Shah, Megan E. Shaw, Gemma Smith, Ryan J. Love, Maya Mukundan, Muhammad Shahid, Ahmad Alareed, Karen Beharry, Ganapathy Bhat, Sanojan Bremakumar, Laurence Caines, Sandra Darko, Nisha Rai, Pedro Vila de Mucha, Phillipa Adams, Helen McDonald, Sam Mills, Frances Parry, Frances Rickard, Stuart Winearls, Rinata Farah, Robert W. Grange, Fiona Herbert, Elizabeth Lonsdale-Eccles, Qurrat Ul Ain
Abstract
PURPOSE: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. METHODS: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. RESULTS: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8-4.6) in CFS 4 vs 1-3; OR 12.4 (6.2-24.5) in CFS 8 vs 1-3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3-1.9) in CFS 4 compared to 0.2 (0.1-0.7) in CFS 8). These risks were both independent of age and dementia. CONCLUSION: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.