Delirium in the emergency department: Incidence and risk factors in a Ligurian hospital

Background

Delirium, a severe neuropsychiatric syndrome characterised by acute deficits in attention and self-awareness, is common among elderly inpatients, with incidence increasing with age and prolonged hospitalisation. This study examines the characteristics of geriatric patients developing delirium in the Emergency Medicine Department, focusing on the relationship between frailty at admission and delirium onset, and how these factors influence hospitalisation decisions and prognosis.

Methods

A prospective, observational study was conducted on patients aged 65+ admitted to the Emergency Department for over 24 hours. Comorbidities (e.g., dementia, cardiovascular diseases, diabetes, COPD, depression, Parkinson’s) and pharmacological therapies (e.g., antipsychotics, antidepressants) were recorded. Frailty was assessed using the Clinical Frailty Scale (CFS).

Results

Among 89 patients (mean age 83.94; 48 women, 41 men), 66.29 % developed delirium, 76.40 % required hospitalisation, and 31.46 % died during their stay. Significant associations were found between delirium and age (p = 0.0025), antipsychotic use (p < 0.0001), CFS score (p = 0.014), and number of medications at admission (p = 0.009). Delirium was also significantly linked to Alzheimer’s disease (p = 0.0033), other dementias (p = 0.0021), anxiety-depressive disorders (p = 0.004), behavioural and psychological symptoms of dementia (BPSD) (p < 0.0001), and mortality (p < 0.0001).

Conclusion

Frailty and delirium are critical factors influencing hospitalisation and prognosis in elderly patients. The study highlights the importance of early frailty assessment and medication review in the Emergency Department to mitigate delirium risk and improve outcomes.