A study published in the American Journal of Geriatric Psychiatry and led by researchers at the Pere Virgili Health Park and the Vall d'Hebron Barcelona Hospital Campus has analysed for the first time delirium and its motor subtypes in a large group of vulnerable older patients in sub-acute care units, associating it with their functional results.
Delirium is a frequent, severe and expensive complication affecting 14 to 56% of older hospitalised patients. It is associated with functional decline, new incidences of dementia or a worsening of a pre-existing dementia, length of hospital stay and mortality, among others. Delirium is classified into three motor subtypes: hyperactive, hypoactive and mixed, although its prevalence and prognosis are still not clearly established.
The researchers have analysed the prevalence of the different subtypes of delirium, their risk factors and results in older patients with multimorbility admitted to a Subacute Care Unit, a geriatric post-acute care ward for short-term management of exarcerbated chronic conditions.
Out of 352 patients with delirium analysed, the hyperactive subtype was the most prevalent one (40.6%), followed by the mixed (31%), the hypoactive (25.9%) and non-motor subtype (2.6%). Institutionalised patients with dementia and/or major disability presented more risk of developing a hypoactive delirium.
There are no data on delirium subtypes in multimorbid, older hospitalised patients and their association with functional, cognitive, nutritional and social status, and with specific chronic conditions or comorbidity.
The study detected different results according to delirium subtypes. Patients with the hypoactive subtype presented a higher mortality rate and higher institutionalisation when compared with patients with the hyperactive subtype. It is worth mentioning that the study is the first to suggest that comorbidity might be independently associated with a higher risk of hipoactive delirium.
The identification of the risk factors and trajectories of the specific motor subtypes of delirium can help to develop better tailored prior to, during and after admission for those patients at risk for delirium.