University of Edinburgh

Dr Rose Penfold

Wellcome Trust PhD fellowship

DL_2023_012

Background: Delirium is a common and serious problem for older people. It is a form of confusion which starts suddenly. Around one in four older people who go to hospital as an emergency are affected. Illness, medicines, and surgery can all cause delirium. It is more common in people with multiple long-term conditions (MLTCs) and in people who are frail. Approach: We will look at links between delirium, MLTCs, and being frail. We will study information for thousands of patients admitted to hospital with a hip fracture or an emergency medical problem. This information is collected in health records from GPs and hospitals. Information will not identify people and will be stored securely. Impact: We are aiming to find out why some people have delirium when they come to hospital, and why some have more problems after being in hospital with delirium. Findings could help to understand the causes of delirium. This study may allow healthcare practitioners to spot the condition earlier and it may help to reduce the bad consequences following a hospital admission with delirium.

Delirium is an acute neuropsychiatric syndrome; it is common in older adults, affecting nearly one-quarter of emergency hospital admissions. Delirium is associated with increased future mortality, care needs, and dementia. MM and frailty are known risk factors for delirium and for poor outcomes, but the nature of these associations remains poorly understood. Few studies have been performed using routine data with robust delirium assessment. In Lothian, the 4 “A”s Test (4AT) is standardised in routine care and has been embedded in EHR since 2016, with ascertainment ~80%. In this project, DataLoch linkage of hospital EHR with GP and community health data will create new insights into pre-admission risk factors for delirium on hospital admission, and better characterise the nature of and risk factors for poor outcomes following a hospital admission with delirium. This will enable better prognostication for patients with delirium at the front door in NHS emergency care, identify potential modifiable risk factors (including those prior to admission in the community), and could lead to specific in-hospital management pathways to mitigate adverse effects of a hospital admission with delirium. We are involving the Public Involvement Network of the Advanced Care Research Centre in the ongoing design of this research, to ensure that outcomes of interest are relevant and to advise on dissemination of findings for public benefit.

Public Health Research

15/01/2024

De-Personalised

TRE