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Affective functioning after delirium in elderly hip fracture patients

Published online by Cambridge University Press:  30 November 2012

Chantal J. Slor ,
Joost Witlox ,
René W. M. M. Jansen ,
Dimitrios Adamis ,
David J. Meagher ,
Esther Tieken ,
Alexander P. J. Houdijk ,
Willem A. van Gool ,
Piet Eikelenboom  and
Jos F. M. de Jonghe
Chantal J. Slor*
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Joost Witlox
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
René W. M. M. Jansen
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Dimitrios Adamis
Affiliation:
Research and Academic Institute of Athens, Athens, Greece
David J. Meagher
Affiliation:
Department of Adult Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland
Esther Tieken
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
Alexander P. J. Houdijk
Affiliation:
Department of Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands
Willem A. van Gool
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
Piet Eikelenboom
Affiliation:
Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
Jos F. M. de Jonghe
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
*
Correspondence should be addressed to: Chantal J. Slor, MSc, Department of Geriatric Medicine, Medical Center Alkmaar, PO Box 501, 1800 AM Alkmaar, the Netherlands. Phone: +31-72-5484068; Fax: +31-72-5482197. Email: c.slor@mca.nl.
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Abstract

Background: Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied.

Methods: For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge.

Results: Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups.

Conclusion: This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.

Trial name: The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient. URL: http://clinicaltrials.gov/ct2/show/NCT00497978?term=taurine+hip+fracture&rank=1. Registration number: NCT00497978.

Keywords

deliriumhip fractureaffectneuropsychiatryanxietyPTSDdepression
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 3 , March 2013 , pp. 445 - 455
Copyright
Copyright © International Psychogeriatric Association 2012

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