Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults.

The study is observational and retrospective, so it cannot prove delirium caused hospital-associated disability; mediation only showed association. Delirium and ADL ratings were collected by unmasked nursing staff, and the same nurse could complete both assessments. Individuals with only one Katz score were classified as not having hospital-associated disability, which may miss decline when discharge or repeat assessments were absent. The analysis was limited to one academic medical center in the Southeastern United States, with low representation of minorities other than African Americans. ICU admissions were excluded, so findings may not apply to more acutely ill patients. Dementia was identified from ICD-10 codes, and the sensitivity and specificity of those codes were not formally evaluated. Excluded participants had more delirium, longer stays, and greater admission ADL impairment, so the included sample may not represent all hospitalized older adults. The disability outcome captured only Katz ADL loss, so lesser functional changes were not measured.

The authors declare no conflicts of interest. Publication types list NIH and other government research support.

Do not conclude that preventing or treating delirium will reduce hospital-associated disability. The study was observational, and the authors state that mediation shows association, not causation.