Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

著者: Waleed Faheem, Taran Nandra, Sarah Richardson, David Saliu, Daisy Wilson, Thomas Jackson, Laura Magill, Lauren McCluskey, Rita Perry, Carly Welch, Daisy Wilson, Claire Copeland, Emma Cunningham, Daniel Davis, Jonathan Treml, Thomas Pinkney, Terence J. Quinn, Peter Nightingale, Benjamin Jelley, Victoria Gaunt, Mary Ní Lochlainn, Kumudhini Giridharan, Mustafa Alsahab, Stephen Makin, Kelli Torsney, Jane Masoli, Lindsay Ronan, Jennifer Kirsty Burton, Oliver Todd, Joanne Taylor, Ruth Willott, Natalie Cox, Róisín Healy, Nedaa Haddad, Sharan Ramakrishna, Zahid Subhan, Antonella Mazzoleni, Olga Nynaes, Jodie Crofts, Emily McNicholas, Hannah Jayne Robinson, Thyn Thyn, Jonathan Baillie, William McKeown, Caroline Rice, Gerrard W. Sloan, Katherine Williamson, Yasmeen Hayat, Vee Han Lim, Katie Millichamp, Amr Bazaraa, Angharad Chilton, Alexander Harbinson, John Headlam, Elisabeth Hunter, Zainab Hussain, Al Wakkass Mahmood, Liji Ng, Srividya Sundara, Felicia Tan, Alice Wheeler, Sophie Wright, Jack B. G. Baldwin, Kate O’shea, Ghazal Hodhody, Kara Mayor, Riana Patel, Shiv Bhakta, Marie Goujon, Adriana Jakupaj, James Dove, Matthew D. Kearney, Vincent McCormack, Kirsty Moore, Leo Pope, Hussun-Ara Shah, Megan E. Shaw, Gemma Smith, Ryan J. Love, Maya Mukundan, Muhammad Shahid, Ahmad Alareed, Karen Beharry, Ganapathy Bhat, Sanojan Bremakumar, Laurence Caines, Sandra Darko, Nisha Rai, Pedro Vila de Mucha, Phillipa Adams, Helen McDonald, Sam Mills, Frances Parry, Frances Rickard, Stuart Winearls, Rinata Farah, Robert W. Grange, Fiona Herbert, Elizabeth Lonsdale-Eccles, Qurrat Ul Ain, Hannah Watson, Celine Bultynck, Chiara Cavaliere, Cal Doherty, Sarah Evans, Daniel S Furmedge, Annabel Hentall MacCuish, Esther Hindley, Caitlin Meyer, Emma Mullarkey, Rosamund Pullen, Aidan Ryan, Dhruv Sarma, Elaine Seymour, Katharine Stambollouian, Darmiga Thayabaran, Chenxian Wu, George Peck, Mahrukh Raza, Kapil Sahnan, A. S. Dhillon, Oluwatosin O. Abiola, Catherine Bryant, Rachael Bygate, John Frewen, Isabel Greaves, Olivia Morrow, Simon Tetlow, Guy Tinson, Aayenah Yunus, Simran Bedi, Olivia Evans, Leeying Giet, Abolfazl Behbahani, Saurav Bhattacharya, Clare Hunt, Rajeev Mishra, Louise Connor, Jack Poynton, Elizabeth Deacon, Rory Durcan, Emma Fisken, Susan A. Hall, Jane Noble, Emma L. Prendergast, Ajay Macharouthu, Victoria Macrae, Emily Murphy-Ackroyd, Emily Rose, Nicola Watt, Mairi Blair, Eilidh R. Mackenzie, Roisin McCormack, Sophie J. Irwin, Alice Einarsson, Ming Khor, Baraa Alhadadi, Ewen Cameron, Angela Campbell, E Capek, Lorna Christie, Laura Connell, Alan Cook, Jordanna Deosaran, Marianne Elliott, Elizabeth Evans, Sarah Fancourt, Sarah B. Henderson, Ambreen Hussain, Karen Jones, Dominic F. Kelly, Catherine M. McErlean, Hazel Miller, Fariha Naeem, C Ostrowski, Megan Parkinson, Fadi Sami, Alison Shepherd, Lindsay Whyte, Emily Wright, E. Ferguson, Michael Gallagher, Heather J. McCluskey, Louise A Beveridge, Hollie A Clements, Jasmine Hart, Neil Henderson, Su Kwan Lim, James Lucocq, Alison McCulloch, Adam A. Murray, Esther E. Y. Ngan, Philippa K. Traill, Amy Walter, Michael Wilson, Abigail Wrathall, Zhi Jiun Yap, Clementine Anderson, Hashem Abu-Arafeh, I. Gluck, Oliver Mitchell, Richard Robson, Elizabeth L Sampson, Arunkumar Annamalai, Jamal Bhatti, Laura Briggs, Debbie Fraser, Jonathan Gui, Eleanor Leah, Natasha Roya Matthews, P. Mithrakumar, Mohammad Moad, Michael Sen, Jacqui Straughan, Roxana Taranu, Kasim Usmani, A. Aamir, Amaka Achara, Olugbenro Akintade, Elizabeth J. Ellis, Sneha Gurung, Chioma Iwu, Abdullah Khalid, Sejlo Koshedo, Shonit Nagumantry, Nader Nashed, Philip Nwabufor, Ijeoma T. Obi, Parrthiepan Visvaratnam, Edward C. Wu, Marc Bertagne, Peter K. Jackson, James E. Allen, Harriet Brown, Jennifer Champion, Natasha Christodoulides, Olivia Handley, Fiona E. Macdonald, Laura Jayne Beeley, Victoria Clayton, Aaron Kay, John Marshall, Hannah Morgan, George Naish, Sarah L. Cleaver, Jenny R. Evans, A. Morrow, Raj Amarnani, Khai Lee Cheah, Claire Cushen, Amy Enfield-Bance, Martin Glasser, Suriti Govindji, S Mani, Jemma Gregory, Puja Jatti, Asma Khan, Helena Lee, Helen Millner, Huma Naqvi, Emily Williamson, Teresa Harkin, Bushra Khizar, Anna Lewis, Hannah Pendleton, Steve Rutter, Rohan Ahmed, Farah Coffey, Beth Hackett, Elizabeth A. Holmes, Ali R. Khan, Zeeshan Mustafa, Mark A. Bowman, James Irvine, Katherine Patterson, Sarah Horner, Ting W. Wong, Christopher Cairns, Kate Foster, Alex Hornsby, Robbie Horton, Laura Jones, Rachel King, Emily Lyon, Ani Tencheva, Faye Wilson, Lesley J. Young, Sindhoora Dama, Eleanor Giblin, Lleika Kunaselan, Olivia Lowes, Reema Menezes, Abigail Taylor, Alex Timperley, Rachel Batho, Charlotte Bell, Sammy Carter, Paul Croft, Eliza Griffiths, Giles Hall, William F. Hunt, Holly Jacques, Felicity Leishman, Seema Murthy, Sinéad Quinn, James Reidm, Amy S. Walker, Stephanie A. Matthews, Ayoub Behbahani, Martin Glasser, Ana Silva Ferreira, Caroline Ashton, Swetha Byravan, Laura Cummings, S. Faruq, Sarah Jagdeo, Philip Thomas, Karen Broadhurst, Joseph B. Wilson, Helen Bowden, Katrin Hoffman, Howell T. Jones, Charles Katz-Summercorn, Ethan Khambay, Lucy L. Porter, James Speed, Keziah Austin, Farrah Bahsoon, Rose Laud, Jawad Ali, Niall Fergusson, Claire Wilkes, Laura Babb, James Gaywood, Jessica Green, Ada Kantczak, Katy Madden, Sasha Porter-Bent, Moe Su Su San, Laxmi Babar, Helen Chamberlain, Tamsin Cricklow, A. Giles, Abhishek Gupta, Clare Hughes, Tammy Lee, Anum Cheema, Yathu Matheswaran, Asiodu Nneamaka, Anekea Ross, Tarunya Vedutla, Theresa J. Allain, Emily Bowen, Julie Dovey, Natalie Gaskell, Deborah Scott, Emma Stratton, Miriam Thake, Stuart Bullock, Siobhan McKay, Stephanie Radoja, Sherif Abdelbadiee, Samuel I. A. Cohen, Jane Giddings, Christopher J. Miller, Emma Mumtaz, Minal D. Patel, Vishnu Prasad, Lahiru Satharasinghe, Mark Studley, Marylin Browne, Sabrina K. Durrant, Emma Jay, Alex McQuillan, Megan Offer, Jessel Varghese, Alexander Barón, Christian Chourot, Peter K. Jackson, Kimberley Kirrane, Helen Rayner, Kate Tantam, Ebrahiem Tumi, Shabnam Venkat, Nisha Aggarwal, Emma Astaire, Karthik Basker, Lexie Berwick, Edward Bilton, Aimee-Louise Chamboult, George E. Chapman, Jasmine Chevolleau, Grace Fenneley, Shannelle House, Nathan Ingamells, Emilia Jewell, Vickneswaran Kalyaani, Mahum Kiani, Nagarjun N Konda, Anusha Kumar, Jo Lai, Jamie Large, Joanna Livesey, Zeinab Majid, J. W. McCready, Hannah Moorey, Bethan Morgan, Kirty Morrison, Alice Mosley, Adam Pailing, Sophie Pettler, Shayan Rashid, Lucy Rimmer, D Scarlett, Gurpreet Sehmbi, Abigail Smith, Nina Smith, Charles Sprosen, Emily Taylor, Jemima Taylor, Connie Tse, Sophie Turton, Henry Vardon, Jasmine Virk, Sarah Warwicker, Hannah Woodman, Beth L. Woodward, Luke Wynne, Ollie Yule, Asim Ahmad, Paapa Appiah-Odame, Ciaran Barlow, D. K.C. Kuek, Isabelle Nicholls, Emma S. Norman, W Pyc, Ashish Vasudev, Lawrence A. T. Adams, Emma Box, Chung Sien Chai, Darcy S. Wilson, Bogna Drozdowska, Emma Elliott, Adam Stirling, Martin Taylor‐Rowan, Hannah Webb, Li Wong, Ahmed Abras, Muhammad Adam, Zarah Amin, Olivia Cooper, Rhianna Davies, Wan Idoracaera C. Ikhwan, Georgia R. Layton, Awolkhier Mohammedseid-Nurhussien, Sohail Shakeel, Hana Waraich, Jabed Ahmed, Katie Ball, Kwasi Debrah, Valérie Page, Zhao Xiao Bei, Hannah McCauley, David McShane, Freya Cooper, Natalie Grundmann, Michael Haley, Andre Le Poideven, Sarah B. McClelland, Emily Moore, Norman Pang, Hannah Currie, Jayne Davies-Morris, Sarah Edwards, Sureena Janagal, Rodric Jenkin, Polly Jones, Gary Kumbun, Sarah Parry, Bhavyas Tyagi, Janine Valentine, Saad Abdullah, Emmy Abu, Sarah Ahmad, Bilquis Ahmed, Hamza Ahmed, Ana Andrusca, Matthew Ansell, Thomas Arkle, Imola Bargaoanu, Charlotte Chuter, Katie Houldershaw, Jacqueline Ibanichuka, Shoaib Iqbal, Angela Kabia, Ismail Kadir, Anjli Krishan, Adam McClean, Gerry McGonigal, Pranav Mishra, Gladys Ofoche, Anna Reay, Simon Stapley, Adam Swietoslawski, Nihaad Syed, Karthika Velusamy, Afnan Wahballa, James Wilcockson - European Geriatric Medicine 2023 被引用: 15

PURPOSE: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. METHODS: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. RESULTS: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8-4.6) in CFS 4 vs 1-3; OR 12.4 (6.2-24.5) in CFS 8 vs 1-3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3-1.9) in CFS 4 compared to 0.2 (0.1-0.7) in CFS 8). These risks were both independent of age and dementia. CONCLUSION: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.