# Risk Factors and Time Course of Incident Delirium Among Older Adults in the Emergency Department (ED)

> **NIH NIH R03** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2024 · $148,500

## Abstract

PROJECT SUMMARY / ABSTRACT
 Adults aged 65 and older represent ~23 million (18%) annual Emergency Department (ED) visits. Delirium,
an acute, fluctuating change in cognition with numerous modifiable and nonmodifiable risk factors, is prevalent
in up to 35% of older adults in the ED. However, the incidence and time course of ED delirium is currently
unknown. Prevention is the only effective treatment, yet only 40% of delirium cases in hospitalized older adults
can be prevented, making prediction and early recognition of patients at-risk of incident delirium – such as in the
ED – vital. Unfortunately, ED providers fail to recognize up to 83% of delirium cases, which can lead to significant
downstream consequences, such as ED revisits, falls, and hospitalizations. Thus, there is a critical need to
identify older adults at highest-risk of delirium in the ED to facilitate early interventions.
 The overall objective of this proposal is to establish the incidence, time course, and risk factors of delirium
during the ED stay, which is a critical prerequisite for implementing effective delirium prevention and
management interventions. We will achieve this objective with the following three aims: (1) Determine the
incidence and time course of ED delirium with validated detection tools, (2) Identify modifiable and nonmodifiable
risk factors of incident ED delirium, and (3) Examine existing risk stratification screening instruments for incident
ED delirium. We propose a prospective cohort study of older adults ≥65yo in a Level 1 accredited Geriatric ED.
We will collect delirium and other cognitive impairment screenings on all patients ≥65yo at ED admission to
establish baseline cognitive status. During the ED stay, patients will be screened for delirium at regular intervals
to determine the incidence and time course of ED delirium. For admitted patients, delirium will continue to be
assessed once per nursing shift during inpatient hospitalization. Using electronic health record data, we will
examine modifiable and nonmodifiable risk factors for delirium in the ED and within 24- and 48- hrs of admission.
Further, we will assess if recommended geriatric risk stratification instruments can predict incident ED delirium.
 Consistent with the goals of the “National Institute on Aging: Strategic Directions for Research, 2020-2025”,
findings from this proposal will improve our understanding of the aging brain and its impact on the prevention,
progression, and prognosis of ED delirium. Specifically, this work will have a positive impact on Geriatric ED care
by identifying a subset of older adults at-risk for delirium. We will also establish the rate and risk factors for
incident ED delirium, which will be the first steps in preventive strategies. During the award period, the candidate
will acquire specific skills in aging research and benefit from interdisciplinary mentorship by accomplished
geriatrics clinician-investigators. This study will serve as the basis for a...

## Key facts

- **NIH application ID:** 10912035
- **Project number:** 5R03AG082923-02
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Rachel Michelle Skains
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $148,500
- **Award type:** 5
- **Project period:** 2023-09-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10912035

## Citation

> US National Institutes of Health, RePORTER application 10912035, Risk Factors and Time Course of Incident Delirium Among Older Adults in the Emergency Department (ED) (5R03AG082923-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10912035. Licensed CC0.

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