Hospitalization Outcomes of Delirium in Patients Admitted to Acute Care Hospitals in Their Last Year of Life: A Population-Based Retrospective Cohort Study

• Published in: Journal of pain and symptom management 2021-06, Vol.61 (6), p.1118-1126.e5
• Main Authors: Webber, Colleen, Watt, Christine L., Bush, Shirley H., Lawlor, Peter G., Talarico, Robert, Tanuseputro, Peter
• Format: Article
• Language: English
• Subjects: Acute services; Clinical decision making; Clinical outcomes; Cohort analysis; Delirium; Discharge; End of life decisions; end-of-life; Health care; Hospitalization; hospitalizations; lengths of stay; Medical diagnosis; Mortality; Neurocognition; Palliative care; Patient care planning; patient discharge; Population-based studies; Risk factors
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.10.029

Delirium is a highly distressing neurocognitive disorder for patients at the end of life. To compare hospitalization outcomes between patients with and without delirium admitted to acute care hospitals in the last year of life. Using linked administrative data from ICES (previously known as the Institute for Clinical Evaluative Sciences), this population-based retrospective cohort study included adults who died in Ontario between January 1, 2014 and December 31, 2016 and were admitted to an acute care hospital in their last year of life. Delirium was identified via diagnosis codes on the hospitalization discharge record. Outcomes included lengths of stay, discharge location, and in-hospital mortality. We used multivariable generalized estimating equations to compare outcomes between patients with and without delirium. Of 208,715 decedents, 9.3% experienced delirium in at least one hospitalization in the last year of life. The mean hospitalization lengths of stay was 13.8 days in patients with delirium (SD = 21.1) or 1.80 times longer (95% CI = 1.75–1.84) compared with those without delirium. Among patients discharged alive, patients with delirium were 1.32 times (95% CI = 1.27–1.38) more likely to be discharged to another institution rather than discharged home. There was no difference in in-hospital mortality between patients with and without delirium (relative risk = 1.01; 95% CI = 0.98–1.05). In the last year of life, hospitalized patients with recorded delirium experience poorer outcomes, including longer lengths of stay and increased risk of postdischarge institution use, compared with those without delirium. These outcomes illustrate added burden for patients, their families, and the health care system, thus highlighting the need for delirium prevention and early detection in addition to informed transitional care decisions.