Impact of Living Arrangements on Delirium in Older ED Patients

Abstract

Background: The purpose of this study is to assess how the socio-family demographic status of patients is related to the onset of delirium in a large cohort of older adults aged ≥65 years evaluated in the emergency department (ED) using a comprehensive geriatric assessment (CGA). Methods: This is a cross-sectional, observational, retrospective study conducted in the ED of a teaching hospital. We enrolled 2770 geriatric patients admitted to the ED from January 2019 to December 2023 and evaluated them using CGA. Clinical variables assessed in the ED were evaluated for associations with delirium onset and in-hospital mortality. Results: Delirium was statistically related to frailty statuses as measured via the Clinical Frailty Scale (CFS) (OR 1.47 [1.39-1.56]; p < 0.001). The occurrence of delirium was also associated with living arrangements: "living with other relatives" condition (OR 1.43 [1.12-1.83]; p = 0.004) and residence in a nursing home (OR 1.72 [1.30-2.31]; p < 0.001). In addition, compared to patients in emergency conditions (NEWS > 5), it emerges that patients with better clinical stability have a lower risk of developing delirium (NEWS 3-5 OR 0.604 [0.48-0.75]; p < 0.001-NEWS < 3 OR 0.42 [0.34-0.53]; p < 0.001). In-hospital mortality was associated with age, male sex, frailty status, clinical instability, and the onset of delirium in the ED. Conclusions: Delirium is a multifactorial and acute syndrome representing a negative prognostic factor of in-hospital mortality, especially in elderly patients. Independent of the clinical condition, the patient's living arrangement could be of relevance to the onset of delirium in the ED. Early comprehensive geriatric assessments in the ED could allow the early detection of all predisposing risk factors, resulting in the timely implementation of supportive strategies to prevent the onset of delirium in EDs.

Keywords: comprehensive geriatric assessment; delirium; emergency department; frailty; living arrangement.

Figure 1

Adjusted cumulative survival for patients with delirium occurrence in the ED compared to controls.