Outcomes of Older Adults With Delirium Discharged From the Emergency Department - 12/03/25

Doi : 10.1016/j.annemergmed.2025.02.003

Annelise S. Howick, BA ^a, Piayeng Thao, BS ^a, Kayla P. Carpenter, BS ^a, Madeline A. Boie, BSc ^a, Ian Ward A. Maia, MD, PhD ^a, Aidan F. Mullan, MA ^b, Susan M. Bower, MSN, RN ^a,^c, Allyson K. Palmer, MD, PhD ^d,^e,^f, Christopher R. Carpenter, MD, MSc ^a,^e, Shan W. Liu, MD, SD ^g, Molly M. Jeffery, PhD, MPP ^a,^f, Fernanda Bellolio, MD, MSc ^a,^e,^⁎
^a Department of Emergency Medicine, Mayo Clinic, Rochester, MN
^b Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
^c Department of Nursing, Mayo Clinic, Rochester, MN
^d Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
^e Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
^f Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
^g Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 12 March 2025

Abstract

Study objective

To compare 30-day mortality and return emergency department (ED) visits among older adults with delirium who are discharged home with those discharged home without delirium and those who are admitted to the hospital with and without delirium.

Methods

Adults aged 75 and older years were assessed for delirium using the Delirium Triage Screen followed by the Brief Confusion Assessment Method. We evaluated outcomes including return visits and 30-day mortality. Models were adjusted by age, sex, dementia, Modified Early Warning Score, and ED length of stay and summarized with adjusted relative risk (aRR) and 95% confidence intervals (CIs).

Results

The study included 22,940 visits. Among them, 202 (0.9%) delirium-positive patients were discharged, and 730 (3.2%) were admitted to the hospital to non-ICU and nonmonitored beds. Discharged patients with delirium had higher 30-day mortality (aRR 2.86, 95% CI 2.04 to 4.00) and were more likely to return to the ED within 30 days (aRR 1.52, 95% CI 1.43 to 1.61) compared with those discharged without delirium. Discharged delirium-positive patients were more likely to return to the ED within 30 days than hospitalized delirium-positive patients (aRR 1.92, 95% CI 1.41 to 1.92), though they experienced lower 30-day mortality (aRR 0.67, 95% CI 0.47 to 0.93). Age, sex, Modified Early Warning Score, dementia, and length of stay were not associated with mortality or ED return.

Conclusion

Patients discharged with delirium experienced a 3-fold increase in mortality within 30 days compared with those discharged without delirium. These findings suggest a need for more precise discharge criteria and enhanced follow-up care for delirious patients to improve safety. Implementing structured screening and tailored postdischarge support could reduce adverse outcomes in this population.

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Keywords : Geriatrics, delirium, Dementia, Mortality, Frailty, Older adult

Plan

Introduction

Background

Goals of This Investigation

Materials and Methods

Study Design, Setting, and Participants

Variables and Measurements

Potential Confounders

Predictors of Mortality or ED Return Among Those With Delirium Dismissed Home

Limitations

Discussion

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Timothy F. Platts-Mills, MD, MSc. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: FB planned and designed the study. AFM conducted the data analysis. ASH drafted the manuscript. All authors substantially contributed to its revision with content expertise. FB Bellolio was this project’s mentor and received grant funding. FB takes responsibility for the manuscript as a whole.
	Data sharing statement: Data dictionary and partial data sets are available on request and after IRB approval.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project was supported in part by the Mayo Clinic Small Grant Program from the CTSA grant number UL1 TR002377 from the National Center for Advancing Translational Science (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. CRC is Associate Editor for the Journal of the American Geriatrics Society and Deputy Editor for Academic Emergency Medicine, serves on the Society for Academic Emergency Medicine Guidelines for Reasonable and Appropriate Care in the Emergency Department committee, serves on the American College of Emergency Physicians Clinical Policy Committee, is Chair of the American College of Emergency Physician’s Geriatric Emergency Department Accreditation Advisory Board, serves on the Clinician-Scientist Transdisciplinary Aging Research Leadership Core, and is an editor for the American College of Emergency Physician’s MyEMCert program.
	Presentation information: This work was presented at the Kogod Center on Aging Symposium, Rochester, MN, June 27, 2024.