Mortality rates have consistently been shown to be greater in patients with delirium compared to those without. Published work over the last decade has revealed however, that several confounding factors play key roles in contributing to the excess mortality in the delirium population and that statistical adjustment for these factors in multivariate analyses minimizes, if not eliminates, the association between delirium and mortality. These factors include pre-existing dementia, advanced age, severe medical illness, diminished functional status, and intoxication or withdrawal from medications. However, studies on prognosis and prognostic indicators of delirium in the past have been limited to subjects admitted to the hospital where the sample may include both incident and prevalent cases of delirium. / Objective. To determine whether prevalent delirium is an independent predictor for mortality among elderly patients seen in the Emergency department. Potentially confounding factors were assessed to reveal their prognostic contributions in this population. Survival analysis was carried out using the Cox Proportional Hazards Modelling technique. / Methods. As part of a larger study, 268 patients seen in the Emergency department in two Montreal hospitals (107 delirium cases, 161 controls) were followed up in 6 month intervals for a total of 18 months. Dates of deaths for the deceased were obtained from the Ministere de la Sante et des Service Sociaux. / Results. The analysis revealed a non-significant association between delirium and mortality rate for the English speaking subjects, when adjusted for age, sex, pre-morbid cognitive decline (IQCODE), Basic ADL, Instrumental ADL, comorbidity, number of medication, education (years), eyesight, and hearing problems (p = 0.752, HR =1 .095, CI: 0.622--1.929). On the other hand, for the French speaking subjects, the same model revealed a highly significant association between delirium and death rate (p = 0.001, HR = 9.078, CI: 2.362--34.892). Possible explanations for the different results are discussed.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.33414 |
| Date | January 2000 |
| Creators | Kakuma, Ritsuko. |
| Contributors | Galbaud du Fort, Guillaume (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Master of Science (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001771234, proquestno: MQ70722, Theses scanned by UMI/ProQuest. |
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