Delirium – Consider prolonged/persistent delirium

Prolonged delirium can be due to new insults

A patient with prolonged delirium should be reassessed to ensure there are not new precipitating factors that are perpetuating.

Examples include new constipation, urinary retention, pain (especially post operative), infections

Alternatively, prolonged/persistent delirium (especially >4 weeks) can occur in a subset (Nature – Outcomes) and is associated with worse mortality, need for institutionalization, and cognitive/functional outcomes

Persistent delirium may occur in up to 20% of patients at 6 months!

Longer duration of delirium is associated with worse global cognition and executive function at 3 and 12 months

Persistent delirium is associated with higher rates of mortality and institutionalization with worse physical and cognitive function (meta-analysis and systematic review)

In practice, these patients rarely – if ever– return to their premorbid baseline