Incidence and risk factors for delirium in older patients with hip fracture.

Abstract

© 2020 The Hong Kong Geriatrics Society and Hong Kong Association of Gerontology. Introduction. Delirium is a common complication of hip fracture that can be avoided or ameliorated by careful anticipatory case management. We aimed to investigate the incidence and risk factors of delirium in older patients with hip fracture treated in our structured integrated care unit, and to evaluate the impact of delirium on healthcare utilisation. Methods. We retrospectively reviewed records of patients aged ≥60 years and admitted to our unit from December 2014 to September 2018 with low-impact hip fracture. Our unit has implemented a structured integrated care programme based on the NICE guidelines. Primary outcome measure was the incidence of delirium. The diagnosis of delirium was established using the Confusion Assessment Method. Secondary outcome measures included length of hospital stay, readmission within 30 days of discharge, and mortality within 30 days and 1 year. Results. A total of 1304 patients were included and classified as non-delirium (349 men and 815 women; mean age, 79.2 years) and delirium (49 men and 91 women; mean age, 82.3 years). The overall within-episode incidence of delirium was thus 10.7%. Independent risk factors for delirium in older patients with hip fractures were age (odds ratio [OR]=1.028, p=0.02), surgical treatment (OR=2.202, p=0.006), dementia (OR=2.066, p=0.001), elevated body temperature (OR=1.966, p=0.001), urinary tract infection (OR=2.431, p<0.001), and acute coronary syndrome (OR=4.587, p<0.001). Those with delirium had prolonged hospitalisation of ≥10 days (OR=2.033, p<0.001) and higher mortality within 30 days (OR=3.408, p=0.002) and 1 year (OR=1.894, p=0.004). Conclusion. The incidence of delirium was low in the present study, compared with most studies. The structured integrated care programme in our unit enables early recognition of delirium for prevention and management of delirium in older patients with hip fracture and might contribute to better outcomes.