In a recent study of 20,495 patients from the US Department of Veterans Affairs health system discharged to skilled nursing facilities after heart failure hospitalization, delirium was associated with poor functional recovery. The baseline Activities of Daily Living score on admission to a skilled nursing facility was significantly worse among patients with delirium; patients with delirium also had significantly lower Activities of Daily Living Improvement from baseline to follow-up assessments.
Heart failure is a chronic, functionally disabling condition. Acute exacerbations of heart failure are a leading cause of hospitalizations and rehospitalizations. Almost 20% of patients with heart failure are unable to function independently and are consequently discharged to skilled nursing facilities (SNFs) to facilitate functional recovery. Delirium is an acute, reversible change in mental status characterized by fluctuations in awareness and attention, which often results in complications such as rehospitalization and delayed discharge from SNFs.
In this study, patients with heart failure discharged to SNFs who had delirium on admission were less likely to demonstrate functional improvement and more likely to experience regression in function compared with patients without delirium. Increased emphasis on identifying and treating delirium for patients with heart failure before discharge and throughout their SNF course may be important for functional recovery. Remember, the key is that delirium is modifiable; it doesn’t have to define the outcomes for your resident’s independence. Please consider this diagnosis when declines in independence are observed upon readmission from acute care.
Stay well, mask up, and stay tuned!