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Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study
Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P.. Journal of general internal medicine, 1998-04-01
Topic: Risk, prevention and care in population studies
Objective To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline. Design Three prospective cohort studies. Setting Three university-affiliated teaching hospitals. Patients Consecutive samples of 727 patients, aged 65 years and older. Measurements and main results Delirium was present at admission in 88 (12%) of 727 patients. The main outcome measures at hospital discharge and 3-month follow-up were death, new nursing home placement, death or new nursing home placement, and functional decline. At hospital discharge, new nursing home placement occurred in 60 (9%) of 692 patients, and the adjusted odds ratio (OR) for delirium, controlling for baseline covariates of age, gender, dementia, APACHE II score, and functional measures, was 3.0, (95% confidence interval [CI] 1.4, 6.2). Death or new nursing home placement occurred in 95 (13%) of 727 patients (adjusted OR for delirium 2.1, 95% CI 1.1, 4.0). The findings were replicated across all sites. The associations between delirium and death alone (in 35 [5%] of 727 patients) and between delirium and length of stay were not statistically significant. At 3-month follow-up, new nursing home placement occurred in 77 (13%) of 600 patients (adjusted OR for delirium 3.0; 95% CI 1.5, 6.0). Death or new nursing home placement occurred in 165 (25%) of 663 patients (adjusted OR for delirium 2.6; 95% CI 1.4, 4.5). The findings were replicated across all sites. For death alone (in 98 [14%] of 680 patients), the adjusted OR for delirium was 1.6 (95% CI 0.8, 3.2). Delirium was a significant predictor of functional decline at both hospital discharge (adjusted OR 3.0; 95% CI 1.6, 5.8) and follow-up (adjusted OR 2.7; 95% CI 1.4, 5.2). Conclusions Delirium is an important independent prognostic determinant of hospital outcomes including new nursing home placement, death or new nursing home placement, and functional decline-even after controlling for age, gender, dementia, illness severity, and functional status. Thus, delirium should be considered as a prognostic variable in case-mix adjustment systems and in studies examining hospital outcomes in older persons.
Key findings
- Measurements and main results Delirium was present at admission in 88 (12%) of 727 patients.
- The associations between delirium and death alone (in 35 [5%] of 727 patients) and between delirium and length of stay were not statistically significant.
- Delirium was a significant predictor of functional decline at both hospital discharge (adjusted OR 3.0; 95% CI 1.6, 5.8) and follow-up (adjusted OR 2.7; 95% CI 1.4, 5.2).
Why it matters
This study found that delirium present at hospital admission in older patients predicted new nursing home placement and functional decline, but was not significantly associated with death alone or length of stay. It is about hospital outcomes of delirium and does not test any treatment, cure, or prevention for Alzheimer's disease.
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Study details
- Study designcohort study
- Participants727
- Effect sizeOR 3.0; OR 2.7
- Evidence strengthModerate
How this study scored 65/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of general internal medicine) |
| Journal's citation record | 3 / 4 | Journal of General Internal Medicine: journal h-index 283 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1998 — older than 20 years, still counted |
| Sample size | 2 / 4 | 727 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 707 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 23.6 citations a year over 30 year(s) since 1998 |
| Impact for its field and year | 4 / 6 | Cited 11.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 12 other studies in this library |
| Still being cited | 2 / 4 | Cited 38 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Peter Pompei: h-index 14 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Yale University: institution h-index 1,927 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 9565386) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 65 / 100 | — |
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Read the original
- DOI: 10.1046/j.1525-1497.1998.00073.x
- PubMed: 9565386
- Original source →
- Free full text: Journal of General Internal Medicine →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Inouye, S. K., Rushing, J. T., Foreman, M. D., Palmer, R. M., & Pompei, P. (1998). Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Journal of general internal medicine. https://doi.org/10.1046/j.1525-1497.1998.00073.x
Vancouver
Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Journal of general internal medicine. 1998. doi:10.1046/j.1525-1497.1998.00073.x. PMID: 9565386.
BibTeX
@article{inouye1998-9565386,
author = {Inouye, S. K. and Rushing, J. T. and Foreman, M. D. and Palmer, R. M. and Pompei, P.},
title = {{Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study}},
journal = {Journal of general internal medicine},
year = {1998},
doi = {10.1046/j.1525-1497.1998.00073.x},
pmid = {9565386},
url = {https://doi.org/10.1046/j.1525-1497.1998.00073.x}
}
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