The impact of frailty and delirium on mortality in older inpatients.

BACKGROUND delirium and frailty are common among hospitalised older people but delirium is often missed and frailty considered difficult to measure in clinical practice. OBJECTIVE to explore the relationship between delirium and frailty in older inpatients and determine their impact on survival. DESIGN AND SETTING the prospective cohort study of 273 patients aged ≥75 years. MEASURES patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Frailty status was measured by an index of accumulated deficits (FI), giving a potential score from 0 (no deficits) to 1.0 (all 33 deficits), with 0.25 used as the cut-off between 'fit' and 'frail'. RESULTS delirium was detected in 102 patients (mean FI: 0.33) and excluded in 171 (mean FI: 0.18) (P < 0.005); 111 patients were frail. Among patients with delirium, the median survival in fit patients was 359 days (95% CI: 118-600) compared with 88 days for those who were frail (95% CI: 5-171; P < 0.05). CONCLUSION delirium was associated with higher levels of frailty: the identification of frail patients may help to target those at a greatest risk of delirium. Survival following delirium was poor with the combination of frailty and delirium conferring a particularly bleak prognosis.