Evidence map›Paper›PMID 29099916›Full record

ArticleThe journals of gerontology. Series A, Biological sciences and medical sciences2018

Delirium, Frailty, and Mortality: Interactions in a Prospective Study of Hospitalized Older People.

Melanie Dani, Lucy H Owen, Thomas A Jackson, Kenneth Rockwood, Elizabeth L Sampson, Daniel Davis

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In one paragraph

Article in The journals of gerontology. Series A, Biological sciences and medical sciences, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Melanie DaniDepartment of Medicine for the Elderly, Hammersmith Hospital, London, UK.
Lucy H OwenUniversity College London Hospitals NHS Foundation Trust, London, UK.
Thomas A JacksonInstitute of Inflammation and Ageing, University of Birmingham, UK.
Kenneth RockwoodDepartment of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Elizabeth L SampsonMarie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK.
Daniel DavisMRC Unit for Lifelong Health and Ageing at UCL, London, UK.

Funding

Marie Curie MCCC-FCO-11-UMedical Research Council MC_UU_12019/1Wellcome Trust 107467/Z/15/ZWellcome Trust WT107467
6 · The paper itself

Abstract

Background: It is unknown whether the association between delirium and mortality is consistent for individuals across the whole range of health states. A bimodal relationship has been proposed, where delirium is particularly adverse for those with underlying frailty, but may have a smaller effect (perhaps even protective) if it is an early indicator of acute illness in fitter people. We investigated the impact of delirium on mortality in a cohort simultaneously evaluated for frailty. Methods: We undertook an exploratory analysis of a cohort of consecutive acute medical admissions aged ≥70. Delirium on admission was ascertained by psychiatrists. A frailty index (FI) was derived according to a standard approach. Deaths were notified from linked national mortality statistics. Cox regression was used to estimate associations between delirium, frailty, and their interactions on mortality. Results: The sample consisted of 710 individuals. Both delirium and frailty were independently associated with increased mortality rates (delirium: HR 2.4, 95% CI 1.8-3.3, p < .01; frailty (per SD): HR 3.5, 95% CI 1.2-9.9, p = .02). Estimating the effect of delirium in tertiles of FI, mortality was greatest in the lowest tertile: tertile 1 HR 3.4 (95% CI 2.1-5.6); tertile 2 HR 2.7 (95% CI 1.5-4.6); tertile 3 HR 1.9 (95% CI 1.2-3.0). Conclusion: Although delirium and frailty contribute to mortality, the overall impact of delirium on admission appears to be greater at lower levels of frailty. In contrast to the hypothesis that there is a bimodal distribution for mortality, delirium appears to be particularly adverse when precipitated in fitter individuals.

Indexed as

Cause of DeathFrail ElderlyAgedDeliriumFemaleGeriatric AssessmentHospitalizationHospital MortalityHumansMaleProspective StudiesRisk Factors

Identifiers

PMID29099916
PMCPMC5861945

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.