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Phenomenological Subtypes of Delirium in Older Persons: Patterns, Prevalence, and Prognosis

Received February 12, 2008; revised May 26, 2008; accepted May 28, 2008. From the Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Dept. of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School; and the Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Dept. of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School. Send correspondence and reprint requests to Frances M. Yang, Ph.D., Assistant Research Scientist, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131. e-mail: francesyang{at}hrca.harvard.edu
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Delirium is an acute confusional state that is common, preventable, and life-threatening. OBJECTIVE: The authors investigated the phenomenology of delirium severity as measured with the Memorial Delirium Assessment Scale among 441 older patients (age 65 and older) admitted with delirium in post-acute care. METHODS: Using latent class analysis, they identified four classes of psychomotor-severity subtypes of delirium: 1) hypoactive/mild; 2) hypoactive/severe; 3) mixed, with hyperactive features/severe; and 4) normal/mild. RESULTS: Among those with dementia (N=166), the hypoactive/mild class was associated with a higher risk of mortality. Among those without dementia (N=275), greater severity was associated with mortality, regardless of psychomotor features, when compared with the normal/mild class. CONCLUSION: The data suggest that instruments measuring delirium severity and psychomotor features provide important prognostic information and should be integrated into the assessment of delirium.

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