Mar-08

Older Adults Discharged from the Hospital with Delirium: 1-Year Outcomes
Gail J. McAvay, PhD, MS, Peter H. Van Ness, PhD, MPH, Sidney T. Bogardus, Jr, MD, Ying Zhang, MD, MPH, Douglas L. Leslie, PhD, Linda S. Leo-Summers, MPHSharon K. Inouye, MD, MPH

OBJECTIVES: To compare 1-year institutionalization and mortality rates of patients who were delirious at discharge, patients whose delirium resolved by discharge, and patients who were never delirious in the hospital.

DESIGN: Secondary analysis of prospective cohort data from the Delirium Prevention Trial.

SETTING: General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998, with follow-up interviews completed in 2000.

PARTICIPANTS: Four hundred thirty-three patients aged 70 and older who were not delirious at admission.

MEASUREMENTS: Patients underwent daily assessments of delirium from admission to discharge using the Confusion Assessment Method. Nursing home placement and mortality were determined at 1-year follow up.

RESULTS: Of the 433 study patients, 24 (5.5%) had delirium at discharge, 31 (7.2%) had delirium that resolved during hospitalization, and 378 (87.3%) were never delirious. After 1 year of follow-up, 20 of 24 (83.3%) patients discharged with delirium, 21 of 31 (67.7%) patients whose delirium resolved, and 157 of 378 (41.5%) patients who were never delirious were admitted to a nursing home or died. Compared with patients who were never delirious, patients with delirium at discharge had a multivariable adjusted hazard ratio (HR) of 2.64 (95% confidence interval (CI)=1.60–4.35) for nursing home placement or mortality, whereas resolved cases had a HR of 1.53 (95% CI=0.96–2.43).

CONCLUSION: Delirium at discharge is associated with a high rate of nursing home placement and mortality over a 1-year follow-up period. Interventions to increase detection of delirium and improvements in transitional care may help reduce these negative outcomes. J Am Geriatr Soc 2006;54(8):1245-1250.

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Effect of Multivitamin and Mineral Supplementation on Episodes of Infection in Nursing Home Residents: A Randomized, Placebo-Controlled Study
Barbara A. Liu, MD, Allison McGeer, MD, Margaret A. McArthur, RN, Andrew E. Simor, MD, Elaheh Aghdassi, PhD, Lori Davis, PhD, and Johane P. Allard, MD

OBJECTIVES: To evaluate the effect of vitamin and mineral supplementation on infections in an elderly institutionalized population.

DESIGN: Eighteen-month, randomized, placebo-controlled trial.

SETTING: Twenty-one long-term care facilities.

PARTICIPANTS: Seven hundred sixty-three subjects from 21 long-term care facilities.

INTERVENTION: Participants were randomized to receive one multivitamin and mineral supplementation daily or placebo.

MEASUREMENTS: The primary outcome was number of infections per subject. Secondary outcomes were antibiotic use and hospitalization rates. Infection control surveillance was conducted over 18 months using standardized criteria.

RESULTS: Outcome data from 748 subjects, mean age 85, were included in the intention-to-treat analysis. Using univariate analyses, there was no difference in infectious episodes between the supplemented and placebo groups (3.5 infections per 1,000 resident-days vs 3.8 infections per 1,000 resident-days, odds ratio (OR)=0.92, 95% confidence interval (CI)=0.82–1.03, P=.12). There was a reduction in antibiotic usage in the supplementation group, but this was not significant in the multivariate model. There was no difference in the number of hospital visits. In the multivariate analysis, the effect of multivitamin use on total number of infections was not significant (OR=0.77, 95% CI=0.54–1.1). Subjects without dementia had a greater rate of infections than those with dementia (OR=1.44, 95% CI=1.19–1.76). In post hoc subgroup analysis, subjects without dementia who received supplementation had a significantly lower rate of infections than those who received placebo (relative risk=0.81, 95% CI=0.66–0.99).

CONCLUSION: Overall, multivitamin and mineral supplementation does not have a significant effect on the incidence of infections in institutionalized seniors, although the subgroup of residents in long-term care without dementia may benefit from supplementation. Further research is needed to determine its effect in high-risk subgroups within the nursing home population. J Am Geriatr Soc 2007;55(1):35-42.