Incidence and risk factors of delirium in the elderly general surgical patient



      This study evaluates the incidence of delirium and risk factors associated with delirium in elderly patients admitted to a general surgical ward.


      Patients aged over 60 years who were admitted with an acute or elective general surgical diagnosis were eligible for this prospective cohort study. Risk factors associated with delirium were analyzed using univariate and multivariate analysis to identify those independently associated with delirium.


      A total of 209 patients were included in the study. The incidence of delirium was 16.9% (23.2% for acute admission, P < .001). Variables associated with delirium were dementia, presence of an urinary catheter, cognitive decline at admission measured with the mini-mental state examination, white blood cell count >10.0 × 109/L, and urea >7.5 mmol/L. Median length of hospital stay was 13 days (range 3–85) for patients with delirium versus 7 (range 1–54) for patients without (P = .002).


      The incidence of delirium is high in elderly patients, especially after an acute admission, leading to an increase in length of hospital stay. To minimize delirium, associated risk factors must be identified and, if possible, treated.


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        • Young J.
        • Inouye S.K.
        Delirium in older people.
        BMJ. 2007; 334: 842-846
        • Siddiqi N.
        • House A.O.
        • Holmes J.D.
        Occurrence and outcome of delirium in medical in-patients: a systematic literature review.
        Age Ageing. 2006; 35: 350-364
        • Schuurmans M.J.
        • Duursma S.A.
        • Shortridge-Baggett L.M.
        • et al.
        Elderly patients with a hip fracture: the risk for delirium.
        Appl Nurs Res. 2003; 16: 75-84
        • Koster S.
        • Oosterveld F.G.
        • Hensens A.G.
        • et al.
        Delirium after cardiac surgery and predictive validity of a risk checklist.
        Ann Thorac Surg. 2008; 86: 1883-1887
        • Bohner H.
        • Hummel T.C.
        • Habel U.
        • et al.
        Predicting delirium after vascular surgery: a model based on pre- and intraoperative data.
        Ann Surg. 2003; 238: 149-156
        • Wacker P.
        • Nunes P.V.
        • Cabrita H.
        • et al.
        Post-operative delirium is associated with poor cognitive outcome and dementia.
        Dement Geriatr Cogn Disord. 2006; 21: 221-227
        • Franco K.
        • Litaker D.
        • Locala J.
        • et al.
        The cost of delirium in the surgical patient.
        Psychosomatics. 2001; 42: 68-73
        • Dyer C.B.
        • Ashton C.M.
        • Teasdale T.A.
        Postoperative delirium. A review of 80 primary data-collection studies.
        Arch Intern Med. 1995; 155: 461-465
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Mungas D.
        In-office mental status testing: a practical guide.
        Geriatrics. 1991; 46 (63, 66): 54-58
        • Katzman R.
        • Brown T.
        • Fuld P.
        • et al.
        Validation of a short Orientation-Memory-Concentration Test of cognitive impairment.
        Am J Psychiatry. 1983; 140: 734-739
        • Schuurmans M.J.
        • Shortridge-Baggett L.M.
        • Duursma S.A.
        The Delirium Observation Screening Scale: a screening instrument for delirium.
        Res Theory Nurs Pract. 2003; 17: 31-50
        • Gemert van L.A.
        • Schuurmans M.J.
        The Neecham Confusion Scale and the Delirium Observation Screening Scale: capacity to discriminate and ease of use in clinical practice.
        BMC Nurs. 2007; 6: 3
        • Ansaloni L.
        • Catena F.
        • Chattat R.
        • et al.
        Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery.
        Br J Surg. 2010; 97: 273-280
        • Inouye S.K.
        • Charpentier P.A.
        Precipitating factors for delirium in hospitalizedelderly persons. Predictive model and interrelationship with baseline vulnerability.
        JAMA. 1996; 275: 852-857
        • Inouye S.K.
        • Viscoli C.M.
        • Horwitz R.I.
        • et al.
        A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics.
        Ann Intern Med. 1993; 119: 474-481
        • Fick D.M.
        • Agostini J.V.
        • Inouye S.K.
        Delirium superimposed on dementia: a systematic review.
        J Am Geriatr Soc. 2002; 50: 1723-1732
        • Lundstrom M.
        • Edlund A.
        • Bucht G.
        • et al.
        Dementia after delirium in patients with femoral neck fractures.
        J Am Geriatr Soc. 2003; 51: 1002-1006
        • Koebrugge B.
        • Koek H.L.
        • van Wensen R.J.
        • et al.
        Delirium after abdominal surgery at a surgical ward with a high standard of delirium care: incidence, risk factors and outcomes.
        Dig Surg. 2009; 26: 63-68
        • Mangnall L.T.
        • Gallagher R.
        • Stein-Parbury J.
        Postoperative delirium after colorectal surgery in older patients.
        Am J Crit Care. 2011; 20: 45-55
        • Litaker D.
        • Locala J.
        • Franco K.
        • et al.
        Preoperative risk factors for postoperative delirium.
        Gen Hosp Psychiatry. 2001; 23: 84-89
        • Marcantonio E.R.
        • Goldman L.
        • Orav E.J.
        • et al.
        The association of intraoperative factors with the development of postoperative delirium.
        Am J Med. 1998; 105: 380-384
        • Olin K.
        • Eriksdotter-Jonhagen M.
        • Jansson A.
        • et al.
        Postoperative delirium in elderly patients after major abdominal surgery.
        Br J Surg. 2005; 92: 1559-1564
        • Kaneko T.
        • Takahashi S.
        • Naka T.
        • et al.
        Postoperative delirium following gastrointestinal surgery in elderly patients.
        Surg Today. 1997; 27: 107-111
        • Dasgupta M.
        • Dumbrell A.C.
        Preoperative risk assessment for delirium after noncardiac surgery: a systematic review.
        J Am Geriatr Soc. 2006; 54: 1578-1589
        • Siddiqi N.
        • Stockdale R.
        • Britton A.M.
        • et al.
        Interventions for preventing delirium in hospitalised patients.
        Cochrane Database Syst Rev. 2007; 2: CD005563
        • Elie M.
        • Cole M.G.
        • Primeau F.J.
        • et al.
        Delirium risk factors in elderly hospitalized patients.
        J Gen Intern Med. 1998; 13: 204-212