Cognitive Impairment, Frail Elderly Syndrome
Conditions
Keywords
postoperative health outcomes, older surgical patients, delirium
Brief summary
The objectives of this study are to determine whether identifying patients with baseline cognitive deficits or frailty predict postoperative delirium.
Detailed description
This project is designed as a prospective, single-center observational study. The cohort will consist of 229 consenting subjects ≥ 70 years of age who present to the Brigham and Women's Hospital Weiner Center for Preoperative Evaluation (CPE) prior to elective spine surgery. These ages are chosen as significant clinical data demonstrate increased cognitive impairment in community dwelling elders. Eligibility criteria include: patients ≥ 70 years of age with an American Society of Anesthesiologists (ASA) physical status classification of I-III presenting for elective spine surgery. Exclusion criteria will include planned Intensive Care Unit (ICU) admission postoperatively, history of stroke or brain tumor, uncorrected vision or hearing impairment (unable to see pictures or read or hear instructions); limited use of the dominant hand (limited ability to draw); and or inability to speak, read, or understand English. Patients will be introduced to the study through a flyer provided to them in their surgeon's office. A study team member will speak with those favorably predisposed to participate to determine if they satisfy eligibility criteria. After obtaining consent, study staff will gain information about the patient's age and years of education. Study staff will administer Health and functional status activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively, and the World Health Organization Disability Assessment Scale \[WHODAS\]) will be administered to all surgical patients. The World Health Organization Disability Assessment Schedule 2.0 is an alternative to the 36-Item Rand Health Survey Short-Form (SF36) to measure physical health and disability. In addition, all patients will be asked if they've had a fall within the last 6 months, whether they've been evaluated for a change in memory or thinking, who accompanied them to their appointment, their employment status and their living situation (alone, institutionalized, living with family members) in a patient survey. The study staff will administer the MiniCog, a simple cognitive screening tool that takes just 2-4 min to complete and has little or no education, language, or race bias. In addition, the Animal Fluency test will be administered, which is a short cognitive screen that takes one minute to complete. Frailty will be measured using the Frail Scale. Other measures of cognitive impairment will be obtained by study staff through: documentation on the patient's standard preoperative form, patient or informant report of diagnosis or evaluation for cognitive impairment or memory concerns, and systematic medical record review. Each enrolled patient will receive a business card listing the investigators' contact information and be advised to expect a follow up telephone up to 6 and 12 months after surgery to verify data elements and reassess functional outcome. Delirium will be assessed prospectively once per day on postoperative days 1, 2, and 3 if the patient remains hospitalized, by a trained study team member using the Confusion Assessment Method \[CAM\]. For patients that are in the Intensive Care Unit (ICU) postoperatively, the Confusion Assessment Method for the ICU (CAM-ICU) will be administered prospectively twice per day on postoperative days 1, 2, and 3 if the patient remains hospitalized by a trained study team member (Attachment-CAM-ICU). Delirium is most common on postoperative days 1-3 and the CAM is a well-validated measure of delirium in surgical patients. For functional status, the WHODAS will be administered 6-12 months postoperatively either by personnel in the surgeon's office as part of routine follow up or by study staff or by telephone. We will also collect information on secondary outcomes including discharge to place other than home (rehabilitation, skilled nursing facility), hospital length of stay (LOS), 30-day reoperation or readmission rate, and 30-day mortality. These outcomes are recorded in the medical record, the BWH Balanced Scorecard, an electronic database of all hospitalized patients that tabulates 31 elements of the hospital event, or the Brigham and Women's Hospital BWH Research Patient Database Enhanced Query. Data will also be confirmed by a follow up telephone interview.
Interventions
OTHERMini Cog
short cognitive screen, short Frailty screen
Sponsors
Brigham and Women's Hospital
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* patients 70 years of age and older presenting to the BWH Weiner Center for Preoperative Evaluation * undergoing elective spine surgery
Exclusion criteria
* include planned ICU admission postoperatively * history of stroke or brain tumor * uncorrected vision or hearing impairment (unable to see pictures or read or hear instructions) * limited use of the dominant hand (limited ability to draw) * inability to speak, read, or understand English.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With or Without Delirium by Surgical Invasivness | up to 3 days post-op | Surgical invasiveness for patients who did or did not develop post-operative delirium as assessed by the confusion assessment method. The levels of invasiveness were categorized clinically as the following: Tier 1 for microdiscectomy, Tier 2 for lumbar laminectomy, anterior cervical, minimally invasive, foraminotomy, facetectomy, Tier 3 for lumbar fusion, trauma, and post-cervical, and Tier 4 for tumor, infection, deformity, and anterior and posterior cervical. Higher tiers indicate greater levels of invasiveness. Since there were very few patients with an invasiveness of 1 or 4 they were placed into two groups, with invasiveness levels I and 2 or 3 and 4. |
| Delirium by Mini-cog Score | up to 3 days post-op | Median mini-cog score of patients who did or did not develop post-operative delirium as assessed by the confusion assessment method. The Mini-Cog is a brief cognitive screening test for visuospatial representation, recall, and executive function. The test involves that includes recalling three words (banana, sunrise, and chair) and a clock drawing. The Mini-Cog has a scale from 0 to 5, a with higher scores suggesting better cognitive performance. One point is designated for each of 3 words recalled and up to two points for the clock drawing component. |
| Number of Participants With or Without Delirium by FRAIL Score | up to 3 days post-op | Robust, pre-frail, and frail patients who did or did not develop post-operative delirium as assessed by the confusion assessment method. |
| Delirium by Age | up to 3 days post-op | The median ages of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. The Confusion Assessment Method (CAM) is a short diagnostic interview for CAM-defined delirium. Delirium is defined as the sudden change in someone's thinking ability that can have devastating consequences and can be very easily missed due to its frequent subtlety. The 4 CAM features assessed by the CAM include: acute onset or fluctuation, inattention, disorganized thinking, or altered level of consciousness. |
| Number of Participants With or Without Delirium by Sex | up to 3 days post-op | Sex of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. |
| Delirium by Body Mass Index | up to 3 days post-op | Median body mass index of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. |
| Number of Participants With or Without Delirium by College Degree | up to 3 days post-op | Counts of patients with a college degree who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. |
| Participants With an ASA Physical Status Score and the Development of Postoperative Delirium | up to 3 days post-op | The ASA Physical Status Classification System assesses and communicates a patient's pre-anesthesia medical co-morbidities and is on a scale of I-VI. This study recruited patients with an ASA physical status of I-III. ASA I is defined as a normal healthy patient, ASA II is defined as a patient with a mild systemic disease, ASA III is defined as a patient with severe systemic disease. ASA physical status of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. |
| Number of Participants With or Without Delirium by Metabolic Equivalent of Task Score < 4 | up to 3 days post-op | Patients with a metabolic equivalent of task (METS) score \< 4 who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. The METS score is a ratio of the working metabolic rate relative to the resting metabolic rate and is one way to describe the intensity of an exercise or activity. This was assessed by the preoperative or surgical study staff. A score of \< 3 is for light intesity activities, 3-6 for moderate intensity activities, and ≥ 6 for vigorous intensity activities. |
| Delirium by Total Number of Medications Taken at Baseline | up to 3 days post-op | Median total number of medications of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. |
| Number of Participants With or Without Delirium by Opioid Use | up to 3 days post-op | Patients with chronic use of opioids who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. |
| Number of Participants With or Without Delirium by Alcohol Consumption | up to 3 days post-op | Patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method based on alcohol consumption. |
| Number of Participants With or Without Delirium by Presence of Depression | up to 3 days post-op | Patients with depression who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. |
| Number of Participants With or Without Delirium by Psychiatric History | up to 3 days post-op | Patients with a history of psychiatric disorders who did or did not develop post-operative delirium as assessed by the confusion assessment method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Participants' Discharge Location (Home vs. Other Than Home) | up to 30 days after the surgical procedure | Location where patients were discharged (Home vs other than home) on the day of patients discharge from the hospital. |
| Number of Participants With In-hospital Complications Were Observed During Their Length of Stay in the Hospital With Death Postoperative Death Monitored up to Day 30. | duration of hospital stay, up to 30 days | In hospital complications after the surgical procedure including: Myocardial Infarction, congestive heart failure (CHF), Cardiac Arrest, Arrythmia, Pneumonia, pulmonary embolism (PE), Reintubation, Stroke, Delirium, Coma\>24h, deep wound infection,Superficial wound infection, Sepsis, Renal Failure, urinary tract infection (UTI), Reoperation, deep vein thrombosis (DVT), intensive care unit (ICU) admission, |
Countries
United States
Participant flow
Recruitment details
Between April 17, 2017 and October 9, 2018, study staff members recruited patients ≥ 70 yr of age scheduled for elective spine surgery at the Brigham and Women's Hospital and were expected to have an inpatient admission after their procedure. We selected this patient population because spine surgery is the third most common surgical procedure in older persons18 and our previous work showed that nearly 20% of this surgical demographic develops delirium postoperatively.
Pre-assignment details
Older patients ≥ 70 years of age presenting for elective spine surgery.
Participants by arm
| Arm | Count |
|---|---|
| Older Surgical Patients Older surgical patients presenting for elective spine surgery by neurosurgeons Dr. Groff, Dr. Lu and Dr. Chi
Mini Cog: short cognitive screen, short Frailty screen | 219 |
| Total | 219 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Did not have their surgery | 5 |
| Overall Study | Withdrawal by Subject | 5 |
Baseline characteristics
| Characteristic | Older Surgical Patients | — |
|---|---|---|
| Age, Categorical <=18 years | 0 Participants | — |
| Age, Categorical >=65 years | 219 Participants | — |
| Age, Categorical Between 18 and 65 years | 0 Participants | — |
| Age, Continuous | 75 Year | — |
| Alcohol consumption No | 94 Participants | — |
| Alcohol consumption Yes | 125 Participants | — |
| Animal Verbal Fluency | 18 animals STANDARD_DEVIATION 6 | — |
| ASA Physical Status ASA 1 or 2 | 70 Participants | — |
| ASA Physical Status ASA 3 or 4 | 149 Participants | — |
| Body Mass Index | 28 kg/m^2 | — |
| Frail Scale Score 0 | 48 Participants | — |
| Frail Scale Score 1-2 | 117 Participants | — |
| Frail Scale Score 3-5 | 53 Participants | — |
| History of depression No | 180 Participants | — |
| History of depression Yes | 39 Participants | — |
| Level of education Bachelors degree or higher | 144 Participants | — |
| Level of education Less than a bachelors degree | 68 Participants | — |
| Metabolic equivalents of task METS < 4 | 60 Participants | — |
| Metabolic equivalents of task METS ≥ 4 | 149 Participants | — |
| Mini-Cog | 4 units on a scale | — |
| Preoperative use of opioids No preoperative use of opioids | 164 Participants | — |
| Preoperative use of opioids preoperative opioid use | 55 Participants | — |
| Psychiatric History No | 197 Participants | — |
| Psychiatric History Yes | 22 Participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Region of Enrollment United States | 219 participants | — |
| Sex: Female, Male Female | 95 Participants | — |
| Sex: Female, Male Male | 124 Participants | — |
| Surgical Invasiveness Tier 1 and 2 | 111 Participants | — |
| Surgical Invasiveness Tier 3 and 4 | 108 Participants | — |
| Total number of medications | 8 total number of medications | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 219 |
| other Total, other adverse events | 0 / 219 |
| serious Total, serious adverse events | 0 / 219 |
Outcome results
Primary
Delirium by Age
The median ages of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. The Confusion Assessment Method (CAM) is a short diagnostic interview for CAM-defined delirium. Delirium is defined as the sudden change in someone's thinking ability that can have devastating consequences and can be very easily missed due to its frequent subtlety. The 4 CAM features assessed by the CAM include: acute onset or fluctuation, inattention, disorganized thinking, or altered level of consciousness.
Time frame: up to 3 days post-op
Population: Patients over the age of 70 undergoing spinal surgeries
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| No Delirium | Delirium by Age | 75 years |
| Delirium | Delirium by Age | 77 years |
p-value: 0.508Wilcoxon (Mann-Whitney)
Primary
Delirium by Body Mass Index
Median body mass index of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method.
Time frame: up to 3 days post-op
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| No Delirium | Delirium by Body Mass Index | 28 kg/m^2 |
| Delirium | Delirium by Body Mass Index | 30 kg/m^2 |
p-value: 0.025Wilcoxon (Mann-Whitney)
Primary
Delirium by Mini-cog Score
Median mini-cog score of patients who did or did not develop post-operative delirium as assessed by the confusion assessment method. The Mini-Cog is a brief cognitive screening test for visuospatial representation, recall, and executive function. The test involves that includes recalling three words (banana, sunrise, and chair) and a clock drawing. The Mini-Cog has a scale from 0 to 5, a with higher scores suggesting better cognitive performance. One point is designated for each of 3 words recalled and up to two points for the clock drawing component.
Time frame: up to 3 days post-op
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| No Delirium | Delirium by Mini-cog Score | 4 scores on a scale |
| Delirium | Delirium by Mini-cog Score | 4 scores on a scale |
p-value: 0.333Wilcoxon (Mann-Whitney)
Primary
Delirium by Total Number of Medications Taken at Baseline
Median total number of medications of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method.
Time frame: up to 3 days post-op
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| No Delirium | Delirium by Total Number of Medications Taken at Baseline | 8 medications |
| Delirium | Delirium by Total Number of Medications Taken at Baseline | 9 medications |
p-value: 0.002Wilcoxon (Mann-Whitney)
Primary
Number of Participants With or Without Delirium by Alcohol Consumption
Patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method based on alcohol consumption.
Time frame: up to 3 days post-op
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by Alcohol Consumption | 98 Participants |
| Delirium | Number of Participants With or Without Delirium by Alcohol Consumption | 27 Participants |
p-value: 0.101Chi-squared
Primary
Number of Participants With or Without Delirium by College Degree
Counts of patients with a college degree who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method.
Time frame: up to 3 days post-op
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by College Degree | 108 Participants |
| Delirium | Number of Participants With or Without Delirium by College Degree | 36 Participants |
p-value: 0.48Chi-squared
Primary
Number of Participants With or Without Delirium by FRAIL Score
Robust, pre-frail, and frail patients who did or did not develop post-operative delirium as assessed by the confusion assessment method.
Time frame: up to 3 days post-op
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by FRAIL Score | Robust (score 0) | 43 Participants |
| No Delirium | Number of Participants With or Without Delirium by FRAIL Score | Pre-frail (score 1 and 2) | 92 Participants |
| No Delirium | Number of Participants With or Without Delirium by FRAIL Score | Frail (score 3-5) | 29 Participants |
| Delirium | Number of Participants With or Without Delirium by FRAIL Score | Pre-frail (score 1 and 2) | 25 Participants |
| Delirium | Number of Participants With or Without Delirium by FRAIL Score | Robust (score 0) | 5 Participants |
| Delirium | Number of Participants With or Without Delirium by FRAIL Score | Frail (score 3-5) | 24 Participants |
p-value: 0.001Chi-squared
Primary
Number of Participants With or Without Delirium by Metabolic Equivalent of Task Score < 4
Patients with a metabolic equivalent of task (METS) score \< 4 who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method. The METS score is a ratio of the working metabolic rate relative to the resting metabolic rate and is one way to describe the intensity of an exercise or activity. This was assessed by the preoperative or surgical study staff. A score of \< 3 is for light intesity activities, 3-6 for moderate intensity activities, and ≥ 6 for vigorous intensity activities.
Time frame: up to 3 days post-op
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by Metabolic Equivalent of Task Score < 4 | 45 Participants |
| Delirium | Number of Participants With or Without Delirium by Metabolic Equivalent of Task Score < 4 | 25 Participants |
p-value: 0.007Chi-squared
Primary
Number of Participants With or Without Delirium by Opioid Use
Patients with chronic use of opioids who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method.
Time frame: up to 3 days post-op
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by Opioid Use | 34 Participants |
| Delirium | Number of Participants With or Without Delirium by Opioid Use | 21 Participants |
p-value: 0.01Chi-squared
Primary
Number of Participants With or Without Delirium by Presence of Depression
Patients with depression who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method.
Time frame: up to 3 days post-op
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by Presence of Depression | 26 Participants |
| Delirium | Number of Participants With or Without Delirium by Presence of Depression | 13 Participants |
p-value: 0.192Chi-squared
Primary
Number of Participants With or Without Delirium by Psychiatric History
Patients with a history of psychiatric disorders who did or did not develop post-operative delirium as assessed by the confusion assessment method.
Time frame: up to 3 days post-op
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by Psychiatric History | 14 Participants |
| Delirium | Number of Participants With or Without Delirium by Psychiatric History | 8 Participants |
p-value: 0.2Chi-squared
Primary
Number of Participants With or Without Delirium by Sex
Sex of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method.
Time frame: up to 3 days post-op
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by Sex | Male | 94 Participants |
| No Delirium | Number of Participants With or Without Delirium by Sex | Female | 70 Participants |
| Delirium | Number of Participants With or Without Delirium by Sex | Female | 25 Participants |
| Delirium | Number of Participants With or Without Delirium by Sex | Male | 30 Participants |
p-value: 0.72Chi-squared
Primary
Number of Participants With or Without Delirium by Surgical Invasivness
Surgical invasiveness for patients who did or did not develop post-operative delirium as assessed by the confusion assessment method. The levels of invasiveness were categorized clinically as the following: Tier 1 for microdiscectomy, Tier 2 for lumbar laminectomy, anterior cervical, minimally invasive, foraminotomy, facetectomy, Tier 3 for lumbar fusion, trauma, and post-cervical, and Tier 4 for tumor, infection, deformity, and anterior and posterior cervical. Higher tiers indicate greater levels of invasiveness. Since there were very few patients with an invasiveness of 1 or 4 they were placed into two groups, with invasiveness levels I and 2 or 3 and 4.
Time frame: up to 3 days post-op
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Delirium | Number of Participants With or Without Delirium by Surgical Invasivness | Tier 1 + 2 | 93 Participants |
| No Delirium | Number of Participants With or Without Delirium by Surgical Invasivness | Tier 3 + 4 | 71 Participants |
| Delirium | Number of Participants With or Without Delirium by Surgical Invasivness | Tier 1 + 2 | 18 Participants |
| Delirium | Number of Participants With or Without Delirium by Surgical Invasivness | Tier 3 + 4 | 37 Participants |
p-value: 0.002Chi-squared
Primary
Participants With an ASA Physical Status Score and the Development of Postoperative Delirium
The ASA Physical Status Classification System assesses and communicates a patient's pre-anesthesia medical co-morbidities and is on a scale of I-VI. This study recruited patients with an ASA physical status of I-III. ASA I is defined as a normal healthy patient, ASA II is defined as a patient with a mild systemic disease, ASA III is defined as a patient with severe systemic disease. ASA physical status of patients who did or did not develop post-operative delirium as assessed by the Confusion Assessment Method.
Time frame: up to 3 days post-op
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Delirium | Participants With an ASA Physical Status Score and the Development of Postoperative Delirium | ASA Physical status of greater than or equal to 3 | 105 Participants |
| No Delirium | Participants With an ASA Physical Status Score and the Development of Postoperative Delirium | ASA Physical Status of less than 3 | 59 Participants |
| Delirium | Participants With an ASA Physical Status Score and the Development of Postoperative Delirium | ASA Physical status of greater than or equal to 3 | 44 Participants |
| Delirium | Participants With an ASA Physical Status Score and the Development of Postoperative Delirium | ASA Physical Status of less than 3 | 11 Participants |
p-value: 0.028Chi-squared
Secondary
Number of Participants With In-hospital Complications Were Observed During Their Length of Stay in the Hospital With Death Postoperative Death Monitored up to Day 30.
In hospital complications after the surgical procedure including: Myocardial Infarction, congestive heart failure (CHF), Cardiac Arrest, Arrythmia, Pneumonia, pulmonary embolism (PE), Reintubation, Stroke, Delirium, Coma\>24h, deep wound infection,Superficial wound infection, Sepsis, Renal Failure, urinary tract infection (UTI), Reoperation, deep vein thrombosis (DVT), intensive care unit (ICU) admission,
Time frame: duration of hospital stay, up to 30 days
Population: All spine surgery patients enrolled in the study.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Delirium | Number of Participants With In-hospital Complications Were Observed During Their Length of Stay in the Hospital With Death Postoperative Death Monitored up to Day 30. | no in-hospital complications | 151 Participants |
| No Delirium | Number of Participants With In-hospital Complications Were Observed During Their Length of Stay in the Hospital With Death Postoperative Death Monitored up to Day 30. | in-hospital complications | 68 Participants |
Secondary
Participants' Discharge Location (Home vs. Other Than Home)
Location where patients were discharged (Home vs other than home) on the day of patients discharge from the hospital.
Time frame: up to 30 days after the surgical procedure
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Delirium | Participants' Discharge Location (Home vs. Other Than Home) | Not documented | 4 Participants |
| No Delirium | Participants' Discharge Location (Home vs. Other Than Home) | Home | 138 Participants |
| No Delirium | Participants' Discharge Location (Home vs. Other Than Home) | Place other than home | 77 Participants |