Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients - American Geriatric Society

Objectives

To determine whether emergency department (ED) length of stay before ward admission is associated with incident delirium in older adults.

Design

Prospective cohort study.

Setting

Hospital.

Participants

Individuals aged 75 and older with delirium at ED entry, coma, aphasia, stroke, language barrier, psychiatric disorder, or alcohol abuse (N = 330).

Measurements

On ED admission, individuals underwent standardized evaluation of comorbidity (Cumulative Illness Rating Scale), cognitive impairment (Short Portable Mental Status Questionnaire), functional independence (activities of daily living, instrumental activities of daily living), pain (Numeric Rating Scale), and acute clinical conditions (Acute Physiology and Chronic Health Evaluation II). During the first 3 days after ward admission, the presence of delirium (defined as ≥1 delirium episodes within 72 hours) was assessed daily using a rapid assessment for delirium (4AT scale). ED length of stay was calculated as the time (hours) between ED registration and when the person left the ED.

Results

ED length of stay longer than 10 hours (odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.13–4.41), moderate to severe cognitive impairment (OR = 5.47, 95% CI = 2.76–10.85), and older age (OR = 1.07, 95% CI = 1.01–1.13) were associated with delirium onset.

Conclusion

ED length of stay longer than 10 hours was associated with greater risk of delirium in hospitalized older adults, after adjusting for age and cognitive impairment.

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