Delirium Occurrence and Associated Factors Among Patients with Dementia and Mild Cognitive Impairment Admitted to Long-Term Care Hospitals: A Cross-Sectional Study
ABSTRACT
Background:
Delirium commonly affects older adults with chronic illnesses, with incidence rates from 21% to 48% depending on severity and condition type. Although there is extensive research on delirium in intensive care units, acute care, and postoperative settings, long-term care (LTC) facilities also have high delirium rates, especially among residents with dementia. Further, patients with mild cognitive impairment (MCI) have a high risk of progressing to dementia.
Objective:
This study aimed to identify the incidence and risk factors of delirium among LTC residents with dementia and MCI, with particular attention to the implications for mental health practice.
Methods:
We conducted a prospective cohort study of 142 LTC residents, including 100 with dementia and 42 with MCI. Delirium was assessed using the Short Confusion Assessment Method by trained nurses. Logistic regression and Shapley additive explanations (SHAP) were employed to determine independent risk factors and visualize their relative importance.
Results:
The overall incidence of delirium was 38.7%, with hypoactive delirium being predominant. In the dementia group, female sex, infection, immobility, analgesic use, and pain were significant risk factors, whereas in the MCI group, diaper use was the strongest predictor. SHAP analysis confirmed that pain and immobility were major contributors across groups. These findings highlight that delirium risk profiles differ between residents with dementia and those with MCI, underscoring distinct mental health vulnerabilities.
Conclusions:
Delirium is highly prevalent among LTC residents with cognitive impairment and has substantial psychosocial implications. Tailored prevention strategies targeting pain, mobility, infection control, and incontinence management are essential. Embedding delirium prevention into LTC mental health frameworks may improve residents’ quality of life and reduce caregiver burden. Clinical Trial: Not applicable. This study is a prospective observational cohort study and was not registered as a clinical trial.
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