Risk factors associated with delirium in older emergency department patients: A systematic review and meta-analysis
Abstract
Background: Delirium is a frequent yet underrecognized neuropsychiatric syndrome among older patients presenting to the emergency department (ED) and is associated with adverse outcomes, including prolonged hospitalization, functional decline, and mortality. Evidence on ED delirium risk factors remains fragmented.
Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from database inception to December 31, 2025. Comparative observational studies of ED patients aged 65 years or older were eligible if delirium was assessed using a validated tool or diagnostic criteria and if a delirium versus non-delirium comparison was available. Studies enrolling only patients with delirium or lacking a non-delirium comparator were excluded from the risk-factor meta-analysis. Adjusted odds ratios (ORs) were preferentially extracted; unadjusted ORs or raw data were used only when adjusted estimates were unavailable. Random-effects models were used for clinically comparable risk-factor domains.
Results: Sixteen comparative observational studies involving 31,543 older ED patients were included. The pooled delirium prevalence was approximately 10%. Factors significantly associated with delirium included advanced age (OR = 1.49, 95% confidence initerval [CI]: 1.13-1.97), baseline cognitive impairment or dementia (OR = 1.90, 95% CI: 1.31-2.76), and medication-related exposures (OR = 1.49, 95% CI: 1.20-1.85). Functional dependence and ED-related environmental…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 31,543 participants or records.
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