Outcomes of Older Adults With Delirium Discharged From the Emergency Department

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.