Delirium in Older Adults Admitted With Acute Stroke: Prevalence, Risk Factors, and In-Hospital Outcomes

Introduction

Delirium is a common, but frequently under-recognised complication in older adults admitted with acute stroke and is associated with adverse clinical outcomes. Data describing the prevalence, clinical profile, and impact of delirium in older adults with acute stroke in Sri Lanka are limited.

Methods

This descriptive cross-sectional study included 90 adults aged ≥60 years admitted with acute ischaemic stroke (including transient ischaemic attack) or haemorrhagic stroke to Professorial Medical Unit at Colombo South Teaching Hospital, Sri Lanka. Delirium was assessed using the Confusion Assessment Method (CAM) at 24 and 72 hours following admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS), frailty using the Clinical Frailty Scale (CFS), functional status using the Barthel Index, and comorbidity burden using the Charlson Comorbidity Index. Categorical variables were analysed using chi-square or Fisher’s exact test, continuous variables using independent samples t-tests or non-parametric tests as appropriate, and univariate logistic regression was used to estimate odds ratios for factors significantly associated with delirium.

Results

The mean age of participants was 67.9 years (SD 7.35), and 68/90 were male. Delirium occurred in 34/90 patients (37.8%). Hypoactive delirium was the most common subtype (22/34), and persistent delirium at both 24 and 72 hours was observed in 23/34 patients. Patients with delirium had significantly higher stroke severity (mean NIHSS 13.41 vs 4.75, p < 0.001) and higher frailty scores (p = 0.036). Dehydration (odds ratio [OR] 12.5, 95% confidence interval [CI] 3.9–40.5; p < 0.001), nasogastric tube use (OR 38.6, 95% CI 8.0–185.0; p < 0.001), urinary catheterisation (OR 43.4, 95% CI 5.4–351.2; p < 0.001), and severe pain (p < 0.001) were significantly associated with delirium. Infections occurred in 4/34 patients with delirium compared with 1/56 without delirium (p = 0.041), and pressure ulcers were observed only in patients with delirium (3/34 vs 0/56; p = 0.031). Median length of hospital stay was longer in patients with delirium (7 days [IQR 3.25]) compared with those without delirium (3 days [IQR 1.25]; p < 0.001)

Conclusions

Delirium affected over one-third of older adults admitted with acute stroke and was associated with greater stroke severity, frailty, modifiable in-hospital risk factors, increased medical complications, and prolonged hospital stay. Early identification and targeted management of delirium risk factors may improve outcomes in this population.