EDITORIAL

Optimizing Delirium Prediction Model in the Management

of Hospitalized Elderly Patients
Kuntjoro Harimurti1,2
Department of Internal Medicine, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital.
Jl. Diponegoro no. 71, Jakarta Pusat 10430, Indonesia.
2
Center for Clinical Epidemiology and Evidence-Based Medicine, Faculty of Medicine, University of IndonesiaCipto Mangunkusumo Hospital, Jakarta, Indonesia. Correspondence mail: kuntjoro.harimurti01@ui.ac.id.
1

One of consequences of aging population

in almost all part of the world is increasing
rate hospitalization of elderly patients.1 Acute
conditions are the most reasons for hospitalization
among this population, but they are usually
already have many chronic comorbidities and
impairments resulting more complications and
difficult managements in hospital.2 One of the
common problems among hospitalized eldery
patients is delirium, which can already occured
when patients were admitted or develop during
hospitalization. 3 Some studies showed that
prevalence of delirium on admission among
elderly patients are between 10-31%, and the
incidence of delirium during hospitalization are
3-29%, depends on in what unit patients were
hospitalized.4
Delirium can be a sign of other serious
medical conditions, such as infections, metabolic
disturbances, hypoxia, dehydration, or drugs
side effect. Delirium commonly occurs in
patients with multiple chronic diseases, cognitive
impairment, decrease of functional status,and
malnutrition.3 Delirious patients have worse
outcomes compared to those who not delirious, in
terms of length of hospital stay, loss of functional
status, prolong cognitive impairment, and
higher rate mortality.4 Nevertheless, diagnosis
of delirium frequently missed by doctors or
other hospital team, either because the diagnosis
of delirium difficult to established or because
low awareness on those who have high risk for
development of delirium.3
In this issue, Isfandiaty et al. report their
retrospective cohort study on prediction of
delirium in hospitalized elderly patients. 5
Based on previously identified risk factors and
precipitating factors, authors found that infections

(with and without sepsis), cognitive impairments,

and decrease of functional status are independent
predictors for development of delirium during
first 14-days of hospitalization. Authors also
established a prediction model which can be
easily applied in daily clinical practice through
a scoring system. Using this scoring system, a
clinician can classified an elderly patient into her/
his risk for development of delirium and therefore
increasing awareness for the delirium occurrence
during hospitalization.
Of course, the scoring system is not meant
to take over the job of the doctor. It is intended
to help doctor make decisions by providing
more objective estimates of probability for
developing delirium in hospitalized elderly
patients, as a supplement to other relevant clinical
information. In high risk patients, doctor should
give more attention and do more effort to prevent
delirium based on known predisposing and
precipitating factors. In addition, the information
can also incorporated in patient and family
education regarding the prognosis of patients and
complication due to hospitalization.
The use of this scoring system is not straight
forward, it needs validationboth internal and
external validationsbefore it can be applied
in clinical practice.6 Therefore, we encourage
the authors and also other researchers to do the
validation study, to test whether this delirium
prediction model is also valid when used in
other setting and population. Furthermore,
considering this kind of research (defined as
clinical epidemiology research) have potential
useful application in clinical practice, we
also encourage other colleagoues to submit
their clinical epidemiology researches in this
Journal. What we mean of clinical epidemiology

Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine

271

Kuntjoro Harimurti

researches are the researches which have aims

that compatible to clinical challenges in daily
practice, i.e.: to establish diagnosis, to determine
etiology/risk factors of a disease, to predict
prognosis, and to choose best treatment. We
believe the evidences from clinical epidemiology
researches will be useful for our colleagoues who
works as clinicians in the management of their
patients.

272

Acta Med Indones-Indones J Intern Med

REFERENCES
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Agency for healthcare and quality. Available from:
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb14.
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2007;334:842-6.
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Incidence and predictors for delirium in hospitalized
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Prognosis and prognostic research:validating a
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