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How Do Delirium and Dementia Increase Length of Stay of Elderly General Medical Inpatients?

Received Feb. 18, 2003; revision received Aug. 20, 2003; accepted Aug. 28, 2003. From Flushing Hospital Medical Center, Flushing, N.Y.; North Shore Long Island Health System, Southside Hospital, Bayshore, N.Y.; Clara Maass Medical Center, Belleville, N.J.; St. Johns’s University, Jamaica, N.Y.; Royal College of Surgeons, Dublin, Ireland; Long Beach Medical Center, Long Beach, N.Y.; University of Pennsylvania Sleep Disorders Clinic, Philadelphia; and Long Island Jewish Medical Center. Address reprint requests to Dr. Saravay, Long Island Jewish Medical Center, 400 Lakeville Rd., New Hyde Park, NY 11040; saravay{at}lij.edu (e-mail).

The purpose of this study was to identify the proximate causes through which dementia and delirium extend length of stay (LOS) in elderly general hospital patients. Among 93 patients age 65 years admitted to a tertiary-care teaching hospital through the emergency department, admission ratings of cognitive impairment, delirium, and dementia predicted the emergence of mental and behavioral manifestations of delirium and dementia in the hospital and greater LOS. Mental and behavioral manifestations also predicted greater LOS. On average, mental manifestations appeared first and were followed by behavioral manifestations, and the appearance of both types of manifestations occurred before the mean LOS. The results suggest that elderly patients with dementia and/or delirium who become symptomatic after admission to a general hospital first show mental signs and symptoms, then show behavioral disturbances, which appear to be the proximate causes of greater LOS.

Key Words: Delirium • Dementia • Length of Stay

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