Abstract
Objective
The aim of our meta-analysis was to update evidence for the association between frailty
and delirium in different types of hospitalized patients, given the large volume of
new studies with inconsistent results.
Design
Systematic review and meta-analysis.
Setting and Participants
In this updated meta-analysis, we searched 3 databases (Embase, PubMed, and the Cochrane
Library) for observational studies, exploring the association between frailty and
delirium from database inception to September 21, 2020, among hospitalized patients.
Relevant data were extracted from the studies that were included. A random effects
model was conducted to synthesize and pool the effect size of frailty on delirium
due to different frailty score instruments, different countries, and various delirium
assessments that were used. The participants enrolled in this meta-analysis were hospitalized
patients.
Measures
Delirium risk due to frailty.
Results
A total of 30 independent studies from 9 countries, consisting of 217,623 patients,
was identified, and the prevalence of frailty ranged from 16.20% to 78.00%. Frail
patients exhibited an increased risk for delirium compared to those without frailty
[odds ratio (OR) 2.96, 95% confidence interval (CI) 2.36–3.71]. In addition, different
types of hospitalized patients had various OR values, which were 2.43 for selective
surgical patients (95% CI 1.88–3.14), 3.61 for medical patients (95% CI 3.61–7.89),
3.76 for urgent surgical patients (95% CI 2.88–4.92), and 6.66 for emergency or critical
illness patients (95% CI 1.41–31.47). Subgroup analysis based on the frailty score
instrument showed the association still existed when using the Clinical Frailty Scale
(OR 4.07, 95% CI 2.71–6.11), FRAIL Scale (OR 2.83, 95% CI 1.56–5.13), Frailty Index
(OR 6.15, 95% CI 3.75–10.07), frailty phenotype (OR 2.30, 95%CI 1.35–5.66), or Erasmus
Frailty Score (OR 2.79, 95% CI 1.63–4.77). However, an association between frailty
and delirium was not observed when the Edmonton Frail Scale was used (OR 1.45, 95%
CI 0.91–2.30).
Conclusions and Implications
A 2.96-fold incremental risk of delirium in frail patients underscores the need for
early screening of frailty and comprehensive delirium prevention. Appropriate interventions
by clinicians should be performed to manage delirium, potentially reducing adverse
clinical outcomes for hospitalized patients.
Keywords
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Article info
Publication history
Published online: February 04, 2021
Footnotes
This work was supported by the Basic Scientific Research Fund for Central Universities, Peking Union Medical College (grant number 3332020007).
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
