Five Questions With: Cyrus Kosar

Cyrus Kosar is a graduate student at Brown University’s School of Public Health. / COURTESY CYRUS KOSAR
Cyrus Kosar is a graduate student at Brown University’s School of Public Health. / COURTESY CYRUS KOSAR

Cyrus Kosar, who earned bachelor’s and master’s degrees in economics from Boston University, came to the Brown University School of Public Health as a graduate student in 2015. His research interests are in aging, long-term care, health economics and quasi-experimental research methods. Kosar, who led a research project that reviewed data from millions of seniors with delirium, shared information with Providence Business News about the results of the study and other issues related to delirium.

PBN: Some 4 percent of the 5.5 million seniors who were admitted to nursing homes between 2011 and 2014 (whose medical records you and your colleagues analyzed) had delirium. Did those results surprise you, and were there significant differences in gender, race or other factors among those who did and didn’t have delirium?

KOSAR: Yes, and no. The admissions we analyzed were coming to nursing homes for post-acute care. Ideally, nobody should be coming from the hospital with delirium. However, this has been known to occur, and the rate we present in our research is lower than that documented by some smaller-scale studies. Delirium was more prevalent among males than females, among older and sicker patients and among those with pre-existing cognitive or functional impairments. These are consistent findings across the body of delirium research.

PBN: How does one develop delirium, what are its symptoms and how can it be treated?

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KOSAR: Delirium is characterized by an acute decline in cognitive function, inattention and either disorganized thinking or an altered level of consciousness. The etiology of delirium is multifactorial. For example, dehydration, infection, sleep deprivation, pain and certain types of medications are all known risk factors for delirium. I’m not a clinician, however, generally it is known that delirium can be managed by addressing its precipitating factors and maintaining a stable, supervised environment for the patient. A good, more comprehensive resource for delirium management is the Hospital Elder Life Program website: www.hospitalelderlifeprogram.org.

PBN: How can health care providers – in hospitals and in nursing homes– distinguish between delirium and dementia?

KOSAR: Dementia is a chronic condition. Delirium is an acute change in mental status. Distinguishing between the two requires measurement of baseline mental status. Hypothetically, a patient with dementia who has low cognitive functioning can still decline from this state, due to delirium. Several delirium instruments can capture delirium, even in patients with dementia. What we use in our study is the Confusion Assessment Method, which is one of the most well-known and most reliable instruments.

PBN: Why do elderly patients with delirium face additional health risks over and above those seniors without delirium, and what are those health risks?

KOSAR: Delirium predisposes patients to multiple health risks, including cognitive and functional decline, prolonged hospital stays, hospital readmissions and mortality. There are two important reasons for why we observe these outcomes. First, as mentioned previously, delirium is usually caused by multiple potentially serious ailments. Second, in most epidemiological studies, researchers are able to identify patients with and without delirium; however, that does not mean that the health care provider is aware of the patient’s condition. Thus, researchers may be observing outcomes for delirium that is potentially unrecognized and unmanaged.

PBN: How can health care providers help reduce the risk for patients with delirium entering a nursing home from being re-hospitalized and/or dying in the short term?

KOSAR: Like most diseases, early detection and care planning could potentially help reduce the likelihood of poor prognoses.

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