Evidence map›Paper›PMID 36931323›Full record

ArticleJournal of the American Medical Directors Association2023

Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults.

Hyun Freeman, Roy C Martin, Caroline Whittington, Yue Zhang, John D Osborne, Tobias O'Leary, Jasmine K Vickers, Kellie L Flood, Rachel M Skains, Alayne D Markland and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Directors Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–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

4 citing papers in PubMed.

  1. Hospital-associated decline: A concept analysis.International journal of nursing studies advances · 2026
    Review
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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

13 authors.

Hyun FreemanDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Roy C MartinDepartment of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Caroline WhittingtonDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Yue ZhangDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
John D OsborneDivision of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Tobias O'LearyDivision of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Jasmine K VickersDepartment of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA.
Kellie L FloodDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Rachel M SkainsDepartment of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Alayne D MarklandDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, USA.
Thomas W BufordDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Cynthia J BrownDepartment of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Richard E KennedyDivision of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: rekenned@uab.edu.

Funding

UAB Health Services Research (HSR) Training ProgramT32HS013852 · AHRQ · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI LEVITAN, EMILY B, MUGAVERO, MICHAEL J · 2003 to 2024
$8.0M
Automating Delirium Identification and Risk Prediction in Electronic Health Records (Supplement)R01AG060993 · NIA · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI KENNEDY, RICHARD E · 2019 to 2022
$1.8M
Speed of Processing Training for Cognitive Deficits After Delirium in Older Adults.R21AG057982 · NIA · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI KENNEDY, RICHARD E · 2017 to 2018
$408k
AHRQ HHS T32 HS013852NIA NIH HHS R01 AG060993NIA NIH HHS R21 AG057982
6 · The paper itself

Abstract

objectiveTo examine whether delirium predicts occurrence of hospital-associated disability (HAD), or functional decline after admission, among hospitalized older adults.

designRetrospective cross-sectional study. SETTING AND

participantsGeneral inpatient (non-ICU) units of a large regional Southeastern US academic medical center, involving 33,111 older adults ≥65 years of age admitted from January 1, 2015, to December 31, 2019.

methodsDelirium was defined as a score ≥2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission. HAD was defined as a decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations with multiple admissions. We performed multivariate and mediation analyses to examine strength and direction of association between delirium and HAD.

resultsOne-fifth (21.6%) of older adults developed HAD during hospitalization and experienced higher delirium rates compared to those not developing HAD (24.3% vs 14.3%, P < .001). Age, presence of delirium, Elixhauser Comorbidity Score, admission cognitive status, admission ADL function, and length of stay were associated (all P < .001) with incident HAD. Mediational analyses found 46.7% of the effect of dementia and 16.7% of the effect of comorbidity was due to delirium (P < .001). CONCLUSIONS AND IMPLICATIONS: Delirium significantly increased the likelihood of HAD within a multivariate predictor model that included comorbidity, demographics, and length of stay. For dementia and comorbidity, mediation analysis showed a significant portion of their effect attributable to delirium. Overall, these findings suggest that reducing delirium rates may diminish HAD rates.

Indexed as

DeliriumDementiaActivities of Daily LivingAgedCross-Sectional StudiesHospitalizationHospitalsHumansIncidenceProspective StudiesRetrospective StudiesRisk Factorsactivities of daily livingcognitionDeliriumdisabilityfunctional impairmenthospitalization

Identifiers

PMID36931323
PMCPMC10370492

What OpenQuestion holds

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Registered trials

None linked

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.