0; 95% CI 2.8–8.9; P < .01). Delirium alone (OR 2.4; 95% CI

1.0–5.7; P = .04) and dementia alone (OR 3.3; 95% CI 2.1–5.3; P < .01) were also significantly associated with institutionalization. Finally, DSD was associated with an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1–2.8; P = .01), whereas an association was not detected between either dementia alone or delirium alone and mortality. No statistically significant association was found for the interaction between delirium and dementia in buy NVP-BKM120 the 3 additional models, including the interaction term delirium and dementia (data not shown). This study specifically investigated the association between DSD and short- and long-term functional outcomes, including the risk of long-term mortality and institutionalization,

in a large population of elderly patients admitted to a rehabilitation setting. DSD was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence at rehabilitation discharge after rehabilitation training and even at 1-year follow-up. Although patients with delirium alone or dementia alone also had higher risks CYC202 of worse functional outcomes at discharge and at 1-year follow-up, these risks appeared lower than in patients with DSD. DSD was also associated with a fivefold increase in the risk of institutionalization and an almost twofold increase in the risk of mortality at 1-year PAK6 follow-up. Previous studies have investigated the role of delirium on functional outcomes but they have not specifically addressed the effect of the combination of delirium and dementia.4 and 21 A first study, carried out in postacute care facilities with a total population of 551 patients, found that persistent or worsening delirium on

admission was significantly associated with poor functional recovery over a 1-week period both in activities of daily living (ADLs) and in instrumental ADLs.21 Only 5% of the sample had a preexisting diagnosis of dementia and no specific analysis addressed the effect of DSD on functional outcomes compared with patients with only delirium or dementia. The study also was limited by the fact that nurses performed delirium assessments without using a specific clinical tool to detect its presence, but used the Minimum Data Set for Post-Acute Care (MDS-PAC). The MDS-based delirium assessment has been recently reported to have limited validity.34 More recently, in a population of 393 elderly patients, Kiely and colleagues4 found that persistence of delirium was a predictor of unsuccessful functional recovery at 2-week and 1-, 3-, and 6-month follow-up. Patients who resolved their delirium by 2 weeks of postacute admission regained 100% of their preadmission functional status, whereas patients for whom delirium never resolved retained less than 50% of their preadmission functional status. Nearly a third of these patients had preexisting dementia.