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Sillner AY, McConeghy RO, Madrigal C, Culley DJ, Arora RC, Rudolph JL. The Association of a Frailty Index and Incident Delirium in Older Hospitalized Patients: An Observational Cohort Study. Clinical Interventions in Aging. 2020 Nov 2; 15:2053-2061.
Introduction/Background: Frailty identifies patients that have vulnerability to stress. Acute illness and hospitalization are stressors that may result in delirium and further accelerate the negative consequences of frailty. Purpose: The purpose of this study was to determine whether frailty, identified at hospital admission and as measured by a frailty index, is associated with incident delirium. Methods: A retrospective, observational, cohort study was done at a Veterans hospital between January 2013 and March 2014. English-speaking patients over 55 years were eligible. Exclusion criteria included inability to complete baseline assessments due to pre-existing cognitive impairment, emergent surgery; and/or admission from a nursing home, pre-existing delirium, and those with psychiatric disease or substance use disorder. Main Outcomes and Measures: Frailty index (FI) variables included cognitive screening, physical function and comorbidities. The FI was calculated as a proportion of possible deficits (range 0 to 1; higher scores indicate increased frailty). Incident delirium was measured daily by an expert clinician interview. Results: A total of 247 patients were admitted and 218 met inclusion/exclusion criteria, with a mean age of 71.54 years (SD = 9.53 years) and were predominantly white (92.7%) and male (91.7%). Participants were grouped using FI ranges as non-frail (FI < 0.25, n = 56 (26%)), pre-frail (FI = 0.25-0.35, n = 86 (39%)), and frail (FI > 0.35, n = 76 (35%)). Pre-frailty and frailty were associated with incident delirium (non-frail: 3.6% vs pre-frail: 20.9% vs frail: 29.3%, = 0.001) and total delirium days (mean day = non-frail 0.04 vs pre-frail 0.35 vs frail 0.57, = 0.003). After adjustment for sociodemographic factors, pre-frail (adjusted OR = 5.64, 95% CI: 1.23, 25.99) and frail status (adjusted OR = 6.80, 95% CI: 1.38, 33.45) were independently associated with delirium. Conclusion: This study demonstrates that a frailty index is independently associated with incident delirium and suggests that admission assessments for frailty may identify patients at high risk of developing delirium.