Functional improvement in hospitalized older adults is independent of dementia diagnosis: experience of a specialized delirium management unit

Abstract

Background: Patients with delirium, especially when superimposed on dementia, are at high risk of functional decline.

Objective: To examine the influence of a multicomponent delirium management program, the geriatric monitoring unit (GMU), on functional progress of delirious older patients and the impact of underlying dementia on functional recovery.

Design: Prospective cohort study.

Setting: The GMU is a specialized 5-bed unit for the care of delirious older adults within an acute tertiary hospital.

Patients: Patients aged 65 years and older with delirium.

Intervention: The GMU is a multifactorial delirium treatment program with core interventions focusing on early mobilization and rehabilitation.

Measurements: Baseline measures included delirium severity (Delirium Rating Scale-98 and Confusion Assessment Method severity), Chinese Mini-Mental State Examination, functional status (modified Barthel Index [MBI]), comorbidity (Charlson's), and illness severity (modified Severity of Illness Index). Patients with and without dementia were compared for recovery in cognitive scores and functional status.

Results: Of 122 patients with delirium who were admitted to the GMU over a 1-year period, 82 (67.2%) had underlying dementia. There were no significant differences in age, gender, delirium severity, illness severity, cognitive performance, and functional status at admission to the GMU between groups, although patients with dementia had significantly higher comorbidity (Charlson's 2.27 vs 1.75, P = 0.05). Significant cognitive and functional improvement was observed for the entire GMU cohort, with demented and nondemented groups capable of functional recovery (MBI gain of 20.43 vs 17.35, respectively, P = 0.35).

Conclusion: Elderly patients with dementia recovering from delirium have comparable potential for functional recovery as their cognitively intact counterparts in a delirium management unit focused on geriatric nursing care and rehabilitation.