Delirium Increases Risks in Alzheimer’s Patients

A study of people with Alzheimer’s disease found that a hospital stay greatly increased the risk of further decline, including the need to enter a nursing home and an increased risk of dying. About half of those who were hospitalized also developed delirium, a condition marked by the rapid onset of confusion and disorientation that further amplified the risk of decline and death.

While hospital stays are often needed to treat a variety of medical conditions in people with Alzheimer’s, the findings confirm earlier concerns about the dangers of hospitalization for those with dementia. They also underline the importance of avoiding delirium in Alzheimer’s patients who enter the hospital.

A visit to the hospital is a troubling experience for anyone. The change of environment, constant noise and activity and painful medical procedures can be particularly disorienting for someone with Alzheimer’s disease.

"Our previous research had found that Alzheimer’s patients experienced a three times faster decline in mental function if they had experienced delirium,” said Dr. Tamara Fong of Beth Israel Deaconess Medical Center in Boston, the lead author of the study. “We wanted to determine if Alzheimer’s disease patients who are hospitalized are at greater risk for poor outcomes than Alzheimer’s patients who are not hospitalized, and if there is any additive negative outcome when hospitalized Alzheimer’s patients develop delirium."

The current study, published in the Annals of Internal Medicine, looked at 771 older men and women with Alzheimer’s. Nearly half required a hospital visit within eighteen months of a doctor’s visit, and about half of those developed delirium during their hospital stay.

People who entered the hospital were at almost five-fold increased risk of death compared to those who didn’t require hospitalization, and were at nearly seven times the risk of needing institutional care after their hospital visit. Those who developed delirium were at even higher risk of mental and physical decline, institutionalization and death.

The findings are a good reminder that hospital stays are a precarious time for anyone with Alzheimer’s and should be avoided whenever possible. They also highlight the need to recognize and treat delirium in order to prevent not just short-term problems but also to avoid long-term repercussions that can last for months beyond the hospital stay.

"Evidence has shown that older patients with Alzheimer's disease are much more likely to be hospitalized than other older patients," said Dr. Fong. "Among the hospitalized Alzheimer's patients, a substantial proportion of risk for adverse outcomes could be attributed to delirium, including 6.2 percent of deaths, 15.2 percent of institutionalization, and 20.6 percent of cognitive decline. The bottom line is that delirium can be a big problem for patients with Alzheimer’s disease."

But delirium can often be prevented, Dr. Fong notes. Effective strategies include the Hospital Elder Life Program, or HELP, which is designed to prevent delirium by keeping hospitalized older people oriented to their surroundings, meeting their needs for nutrition, fluids and sleep, and keeping them mobile as much as possible.

"Going forward, we plan to conduct formal studies to determine if these types of interventions can help improve outcomes for this vulnerable group of patients," she explains.

Steps to prevent hospitalizations in the first place are also critical, especially for anyone with Alzheimer’s disease, the authors note.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: Tamara G. Fong, MD, PhD; Richard N. Jones, ScD; Edward R. Marcantonio, MD, SM; et al: “Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease.” Annals of Internal Medicine, Vol. 156 (No. 12), June 19, 2012, pages 848-856.