Course and prognosis

Evidence is limited. (!5) The usual clinical experience is that delirium is a disorder which is seen as appropriate to acute illness, is not specifically diagnosed, and usually has a good outcome. Those who have recovered from delirium often have little memory of what happened, but a small minority may have distressing memories of being frightened and of being unable to understand what was happening to them.

In the elderly, research confirms clinical experience that delirium may proceed not only to death or to recovery, but that it is frequently followed by survival with impairment. A systematic review and meta-analysis examined the prognosis of delirium in the elderly:(7) eight reports involved 573 patients with delirium. At 1 month after admission 46.5 per cent were in institutions, and 14.2 per cent had died; only 54.9 per cent had improved mentally. At 6 months after admission 43.2 per cent were in institutions. Compared with unmatched control subjects they had longer hospital stays, higher mortality rates at 1 month, and higher rates of institutional care at 1 and 6 months. The presence of severe physical illness or dementia may have been related to some outcomes. The authors concluded that delirium in the elderly appears to have a poor prognosis, although this finding may have been confounded by the presence of concomitant dementia or severe physical illness.

Treloar and MacDonald(5) confirmed that the clinical diagnosis of delirium in geriatric medical inpatients did not necessarily indicate that survivors would have normal cognitive function, as judged by the Mini-Mental State Examination.

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