Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 May;43(3):326-33.
doi: 10.1093/ageing/afu022. Epub 2014 Mar 6.

Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis

Suman Ahmed  1 , Baptiste Leurent, Elizabeth L Sampson
Affiliations
Meta-Analysis

Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis

Suman Ahmed et al. Age Ageing. 2014 May.

Abstract

Background: delirium affects up to 40% of older hospitalised patients, but there has been no systematic review focussing on risk factors for incident delirium in older medical inpatients. We aimed to synthesise data on risk factors for incident delirium and where possible conduct meta-analysis of these.

Methods: PubMed and Web of Science databases were searched (January 1987-August 2013). Studies were quality rated using the Newcastle-Ottawa Scale. We used the Mantel-Haenszel and inverse variance method to estimate the pooled odds ratio (OR) or mean difference for individual risk factors.

Results: eleven articles met inclusion criteria and were included for review. Total study population 2338 (411 patients with delirium/1927 controls). The commonest factors significantly associated with delirium were dementia, older age, co-morbid illness, severity of medical illness, infection, 'high-risk' medication use, diminished activities of daily living, immobility, sensory impairment, urinary catheterisation, urea and electrolyte imbalance and malnutrition. In pooled analyses, dementia (OR 6.62; 95% CI (confidence interval) 4.30, 10.19), illness severity (APACHE II) (MD (mean difference) 3.91; 95% CI 2.22, 5.59), visual impairment (OR 1.89; 95% CI 1.03, 3.47), urinary catheterisation (OR 3.16; 95% CI 1.26, 7.92), low albumin level (MD -3.14; 95% CI -5.99, -0.29) and length of hospital stay (OR 4.85; 95% CI 2.20, 7.50) were statistically significantly associated with delirium.

Conclusion: we identified risk factors consistently associated with incident delirium following admission. These factors help to highlight older acute medical inpatients at risk of developing delirium during their hospital stay.

Keywords: delirium; hospitalised; medical unit; older people; risk factors.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Selection of studies for review.
See this image and copyright information in PMC

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Arlington VA: American Psychiatric Association; 2000.
    1. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35:350–64. - PubMed
    1. Inouye SK, Bogardus ST, Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–76. - PubMed
    1. Young J, Murthy L, Westby M, Akunne A, O'Mahony R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ. 2010;341:c3704. - PubMed
    1. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275:852–7. - PubMed

Publication types

MeSH terms