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The Occurrence and Persistence of Symptoms Among Elderly Hospitalized Patients

Sue E. Levkoff, ScD; Denis A. Evans, MD; Benjamin Liptzin, MD; Paul D. Cleary, PhD; Lewis A. Lipsitz, MD; Terrie T. Wetle, PhD; Catherine H. Reilly, MSN; David M. Pilgrim, MD; Joshua Schor, MD; John Rowe, MD

Arch Intern Med. 1992;152(2):334-340.

Abstract
We evaluated the occurrence and persistence of delirium in 325 elderly patients admitted to a teaching hospital from either a defined community or a long-term care facility. Of the study participants, 34 (10.5%) had Diagnostic and Statistical Manual of Mental Disorders, Third Edition-defined delirium at initial evaluation; of the remaining patients, 91 (31.3%) developed new-onset delirium. An additional 110 patients also experienced individual symptoms of delirium without meeting full criteria. Preexisting cognitive impairment and advanced age were associated with increased risk of incident delirium in the community sample but not the institutional one. Delirium was not associated with an increased risk of mortality, but it was associated with a prolonged hospital stay and an increased risk of institutional placement among community-dwelling elderly. Only five patients (4%) experienced resolution of all new symptoms of delirium before hospital discharge, and only 20.8% and 17.7%, respectively, had resolution of all new symptoms by 3 and 6 months after hospital discharge. These data suggest that delirium is a common disorder that may be substantially less transient than currently believed and that incomplete manifestations of the syndrome may be frequent.

(Arch Intern Med. 1992;152:334-340)

Author Affiliations
From the Division on Aging, Harvard Medical School, Boston, Mass (Drs Levkoff and Cleary); Center for Research on Health and Aging, St Luke's Medical Center, Chicago, Ill (Dr Evans); Department of Psychiatry, Baystate Medical Center, Springfield, Mass (Dr Liptzin); Hebrew Rehabilitation Center for Aged, Roslindale, Mass (Drs Lipsitz and Schor); Braceland Center for Mental Health and Aging, The Institute of Living, Hartford, Conn (Dr Wetle); Beth Lsrael Hospital, Boston (Ms Reilly); Harvard Community Health Plan, Medford (Mass) Center (Dr Pilgrim); and Mount Sinai School of Medicine, New York, NY (Dr Rowe).

Footnotes
Accepted for publication August 23, 1991.

Reprint requests to Division on Aging, Harvard Medical School, 643 Huntington Ave, Boston, MA 02115 (Dr Levkoff).

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