Potential Risk Factors for, and Clinical Implications of, Delirium during Inpatient Rehabilitation: A Matched Case-Control Study

Marco G Ceppi; Marlene S Rauch; Julia Spöndlin; Andreas R Gantenbein; Christoph R Meier; Peter S Sándor

doi:10.1016/j.jamda.2023.01.012

Potential Risk Factors for, and Clinical Implications of, Delirium during Inpatient Rehabilitation: A Matched Case-Control Study

J Am Med Dir Assoc. 2023 Apr;24(4):519-525.e6. doi: 10.1016/j.jamda.2023.01.012. Epub 2023 Feb 21.

Authors

Marco G Ceppi¹, Marlene S Rauch², Julia Spöndlin², Andreas R Gantenbein³, Christoph R Meier⁴, Peter S Sándor⁵

Affiliations

¹ Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Neurorehabilitation and Research Department, ZURZACH Care, Bad Zurzach, Switzerland.
² Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.
³ Neurorehabilitation and Research Department, ZURZACH Care, Bad Zurzach, Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
⁴ Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland; Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
⁵ Neurorehabilitation and Research Department, ZURZACH Care, Bad Zurzach, Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland. Electronic address: peter.sandor@zurzachcare.ch.

PMID: 36828136
DOI: 10.1016/j.jamda.2023.01.012

Abstract

Objectives: To investigate the association between a wide set of baseline characteristics (age, sex, rehabilitation discipline), functional scores [Functional Independence Measure (FIM), cumulative Illness Rating Scale (CIRS)], diseases, and administered drugs and incident delirium in rehabilitation inpatients and, furthermore, to assess clinical implications of developing delirium during rehabilitation.

Design: Matched case-control study based on electronic health record data.

Setting and participants: We studied rehabilitation stays of inpatients admitted between January 1, 2015, and December 31, 2018, to ZURZACH Care, Rehaklinik Bad Zurzach, an inpatient rehabilitation clinic in Switzerland.

Methods: We conducted unconditional logistic regression analyses to estimate adjusted odds ratios (AORs) with 95% CIs of exposures that were recorded in ≥5 cases and controls.

Results: Among a total of 10,503 rehabilitation stays, we identified 125 validated cases. Older age, undergoing neurologic rehabilitation, a low FIM, and a high CIRS were associated with an increased risk of incident delirium. Being diagnosed with a bacterial infection (AOR 2.62, 95% CI 1.06-6.49), a disorder of fluid, electrolyte, or acid-base balance (AOR 2.76, 95% CI 1.19-6.38), Parkinson's disease (AOR 5.68, 95% CI 2.54-12.68), and administration of antipsychotic drugs (AOR 8.06, 95% CI 4.26-15.22), antiparkinson drugs (AOR 2.86, 95% CI 1.42-5.77), drugs for constipation (AOR 2.11, 95% CI 1.25-3.58), heparins (AOR 2.04, 95% CI 1.29-3.24), or antidepressant drugs (AOR 1.88, 95% CI 1.14-3.10) during rehabilitation, or an increased anticholinergic burden (ACB ≥ 3) (AOR 2.59, 95% CI 1.41-4.73) were also associated with an increased risk of incident delirium.

Conclusions and implications: We identified a set of factors associated with an increased risk of incident delirium during inpatient rehabilitation. Our findings contribute to detect patients at risk of delirium during inpatient rehabilitation.

Keywords: Delirium; case-control study; inpatient rehabilitation; risk factors.

MeSH terms

Case-Control Studies
Delirium* / epidemiology
Hospitalization
Humans
Inpatients*
Risk Factors