A recent multicenter cohort study involving 2,556 hospitalized adults aged 65 and older across five countries (Brazil, Angola, Chile, Colombia, and Portugal) has revealed critical insights into the relationship between delirium and 90-day mortality. The study, conducted from June 2022 to December 2023, utilized the Confusion Assessment Method for delirium assessment and the Clinical Dementia Rating (CDR) scale to evaluate cognitive status. Notably, delirium was identified in 37% of patients, with prevalence increasing significantly alongside cognitive decline (from 16% in CDR 0 to 77% in CDR 2-3).

The findings underscore the prognostic significance of delirium, demonstrating an adjusted hazard ratio of 3.45 for 90-day mortality associated with delirium. This association was particularly pronounced in patients without dementia, where cumulative mortality rates reached 54% for those experiencing delirium compared to 15% for those without. In contrast, the mortality risk was lower but still significant among patients with moderate to severe dementia, indicating that while delirium is more frequent in this group, its impact on mortality is less severe.

These results highlight a crucial therapeutic implication for clinical practice and research. The pronounced mortality risk associated with delirium in cognitively intact older adults suggests an urgent need for intervention trials aimed at delirium prevention and management. Establishing effective strategies could potentially reduce mortality rates in this vulnerable population, shifting the focus of geriatric care towards proactive measures that address delirium as a critical factor in healthspan and longevity.

Source: academic.oup.com