# Risk factors and outcomes of hyperactive delirium in older medical inpatients admitted to non-intensive care unit: a prospective cohort study

## TL;DR

This study finds that hyperactive delirium in older hospital patients is linked to higher mortality and identifies risk factors like frailty and cognitive impairment.

## Contribution

The study identifies specific risk factors and shows a strong link between hyperactive delirium and 90-day mortality in older non-ICU patients.

## Key findings

- Hyperactive delirium was diagnosed in 48.3% of patients with an incidence rate of 101.1 per 1000 person-days.
- Patients with hyperactive delirium had an 8.23-fold increased risk of 90-day mortality after discharge.
- Risk factors included urinary incontinence, frailty (CFS ≥ 5), and cognitive impairment (MoCA < 25).

## Abstract

Hyperactive delirium is a common complication in older medical inpatients in non-intensive care units. This condition increases the risk of diminished physical function, morbidity, and mortality. Moreover, antipsychotics and sedatives were widely used in these patients, contributing to many drug interactions and adverse drug reactions. This study aimed to evaluate the risk factors for hyperactive delirium and assess adverse outcomes among these susceptible patients.

We conducted a prospective observational study to examine hyperactive delirium as an exposure and its association with adverse outcomes without intervention. A total of 238 medical patients aged ≥ 60 admitted to non-intensive care units at Ramathibodi Hospital between September 1, 2022, and December 31, 2023, were enrolled. The clinical characteristics, physical examination, and biochemical profiles at baseline were assessed. Adverse clinical outcomes at 90 days after discharge were evaluated by reviewing electronic medical records (EMRs). The Confusion Assessment Method and Richmond Agitation-Sedation Scale (RASS) score of + 1 to + 4 were used to diagnose hyperactive delirium. The Cox proportional hazard model was performed to identify risk factors and adverse clinical outcomes associated with hyperactive delirium, with results reported as hazard ratios (HRs) and 95% confidence intervals (CIs).

Overall, hyperactive delirium was diagnosed in 115 (48.3%) patients and had an incidence rate of 101.1 cases per 1000 person-days. The risk factors for hyperactive delirium were urinary incontinence (HR 1.69, 95% CI 1.11–2.57), clinical frailty scale (CFS) ≥ 5 (HR 2.79, 95% CI 1.69–4.62), and Montreal Cognitive Assessment (MoCA) score < 25 (HR 4.63, 95% CI 1.09–19.75). Within 90 days after discharge, 14 (12.2%) patients with delirium had died. Medical inpatients who experienced hyperactive delirium had an 8.23-fold increased risk of 90-day mortality following hospital discharge compared to those without delirium (HR 8.23, 95% CI 1.38–48.98).

The risk factors for hyperactive delirium were urinary incontinence, frailty (CFS score ≥ 5), and cognitive impairment (MoCA score < 25). Among older medical inpatients, hyperactive delirium was an independent predictor of 90-day mortality after discharge.

The online version contains supplementary material available at 10.1186/s12888-025-06731-5.