By Megan Alexander
This research was provided to determine delirium as an independent factor that contributes to hospital outcomes including mortality, functional decline and institutionalization. Delirium (acute disorder of attention and global cognitive functioning ) is an important independent which can be used as a prognostic base of determination of hospital outcomes, such as : nursing home placement, death or new home placement, and functional decline.
As the previous studies show, delirium has connection with poor outcomes, increased mortality rates, prolonged length of hospital stay , increased level of institutional placement, functional and cognitive decline. The aim of this study is to reveal if delirium can be the reason of concrete diseases and can contribute to the prognosis. On the other hand, it can be just identify patients with severe illness, dementia, functional impairment, who have poor prognostic features.
The three study population of three different institutions was used. University of Chicago Hospitals, University Hospitals of Cleveland, and Yale-New Haven Hospital were involved as a part of the Hospital Outcomes Project for the Elderly (HOPE). The study included inclusion and exclusion criteria. 727 hospitalized older patient with entry age criteria form 65 to 75 years were examined. The research assessment based on the standardized interviews results including also a shortened version of the Mini-Mental State Examination (MMSE).
The admission interviewing were held within 48 hours . The interview itself included demographic information, activities of daily living (ADLs), instrumental activities of daily living (IADLs), MMSE, and Confusion Assessment Method (CAM) rating. The discharge interview had in addition determination of discharge location. As the major study outcomes served death, new nursing home placement, death or new nursing home placement , or ADL decline.
Within the statistical analysis of the studied data Pearsons x 2 test , Student’s t test, crude and adjusted odds ratios, baseline covariates methods were used. All the baseline covariates were included in models for outcomes of health, new nursing home placement, death or new nursing home placement.
The analysis results, arranged in two data tables, showed that the baseline rates of delirium were similar in the three cohorts with an overall rate of 88%. But these cohorts have significant statistical differences in many baseline characteristics. The disadvantages of this study include limited baseline characteristics, a large amount of missing data, narrow age criteria, comparatively short period of a study observation. The cases of delirium shouldn’t be studied only by older patients. This cases should be examined in all ages , though it appears mostly by seniors. By studying all the cases of delirium with a larger amount of questionnaires it will be possible to define delirium as an important prognostic determinant of hospital outcomes.
So, this study should be continued. But the advantages of the current study include the variety of statistical methods, which proved data on appropriateness for further conclusions. The positive side was that the study experiment was held in three different places outlining some regional factors. But in the next study more institutions should be involved. The result of a multisided nature of this study was a large number of the study outcomes.
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