Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Geriatric Medicine Research Collaborative

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Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom.

Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded.

Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia.

Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.

Original languageEnglish
JournalEuropean Geriatric Medicine
Early online date25 Jan 2023
Publication statusE-pub ahead of print - 25 Jan 2023

Bibliographical note

Funding Information:
The research was sponsored by the University of Birmingham. This study received support for project delivery and coordination from the Birmingham Surgical Trials Consortium via core funding from the National Institute for Health Research (NIHR) Clinical Research Network West Midlands allocated to help support new research collaboratives. The sponsor was not involved in design, methods, subject recruitment, data collections, analysis, or preparation of the manuscript. The views expressed in this manuscript are those of the authors are not the NIHR, National Health Service, or Department of Health.

Publisher Copyright:
© 2023, The Author(s).


  • Delirium
  • Frailty
  • Mortality
  • Recognition

ASJC Scopus subject areas

  • Gerontology
  • Geriatrics and Gerontology


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