Delirium Bibliography

Reference Information

Title

Cognitive and functional change in skilled nursing facilities: Differences by delirium and Alzheimer's disease and related dementias

Authors

Saczynski, J. S. Koethe, B. Fick, D. M. Vo, Q. T. Devlin, J. W. Marcantonio, E. R. Briesacher, B. A.

Year

2024

Journal

J Am Geriatr Soc

Abstract

BACKGROUND: Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer’s disease related dementias (ADRD) has not been examined. OBJECTIVE: To compare change in cognition and function among short-stay SNF patients with delirium, ADRD, or both. DESIGN: Retrospective cohort study using claims data from 2011 to 2013. SETTING: Centers for Medicare and Medicaid certified SNFs. PARTICIPANTS: A total of 740,838 older adults newly admitted to a short-stay SNF without prevalent ADRD who had at least two assessments of cognition and function. MEASUREMENTS: Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD-9 codes, and incident ADRD by ICD-9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale. RESULTS: Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD-only and delirium-only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD. CONCLUSIONS: Among older adults without dementia admitted to SNF for post-acute care following hospitalization, a positive screen for delirium and a new diagnosis of ADRD, within 7 days of SNF admission, were both significantly associated with worse cognitive and functional recovery. Patients with both delirium and new ADRD had the worst cognitive and functional recovery.

PMID

PMID: 39171670

Keywords

Alzheimer’s disease and related dementias
cognition
delirium
function
skilled nursing facilities

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