Companionship at hospital discharge and its association with subsequent delirium onset in older adults : the TRADE observational study

Background Little is known about the role of cross-sectoral companionship (CSC) at hospital discharge or transfer to another facility/department and subsequent delirium incidence in older adults. We aimed to identify predictors of optimal CSC, and to evaluate its association with delirium incidence after discharge/transfer in this population. Methods Participants aged ≥ 70 years and their caregivers were recruited in four hospitals in Germany from 08/2019 to 02/2020, and asked standardized questionnaires prior to as well as 3, 7 and 90 days after discharge/transfer. CSC was classified according to its occurrence: before, during and/or after discharge/transfer, defined as optimal when reported before and after or before, during and after. Incident delirium was identified by confusion assessment method (CAM), family-CAM (FAM-CAM) and nursing delirium screening scale (Nu-DESC) (composite outcome). Logistic regression was performed to identify predictors of optimal CSC, and to evaluate the association between CSC and delirium. Results Among 163 participants (median age 80.8 years, 55.8% women) 61 (37.4%) reported optimal CSC, with social contact with daughter and son-in-law and length of hospital stay identified as positive, and former alcohol consumption and transport by ambulance as negative predictors. Among 92 participants (median age 81.6 years, 56.5% women) with complete data on the presence or absence of delirium a 20.7% 95% CI 13.6; 30.0 7-days delirium incidence proportion was observed. No association between optimal CSC and subsequent delirium onset was detected. Conclusion Only one third of patients reported optimal CSC at discharge/transfer, with social contact and length of hospital stay as positive, and former alcohol consumption and the use of an ambulance as negative predictors for an optimal CSC. Although no association between CSC and subsequent delirium could be identified in the present study, the fact that one fifth of discharged patients developed delirium highlights the importance of delirium-preventing measures around the time of discharge.