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Whether this prognostic association varies by baseline cognition is uncertain. We evaluated the association between delirium and 90-day mortality and whether baseline cognitive status modified this relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective, multicentre cohort study of adults aged \u226565\u00a0years admitted to 43 hospitals in five countries (Brazil, Angola, Chile, Colombia and Portugal; June\u00a02022\u2013December\u00a02023). Delirium was assessed using the Confusion Assessment Method; cognitive status was measured using an informant-based Clinical Dementia Rating (CDR). Mortality within 90\u00a0days of admission was ascertained from hospital records, structured telephone follow-up by blinded assessors and registry linkage. We used mixed-effects survival models with random intercepts (state\/province and study centre) and sequential adjustment for sociodemographic, clinical and hospital-related factors. Effect modification by CDR was examined with stratified analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2556 patients (mean age 79\u2009\u00b1\u20099\u00a0years; 56% women), delirium occurred in 957 (37%). Delirium frequency rose with worsening cognition (CDR\u00a00: 16%; CDR\u00a00.5: 27%; CDR\u00a01: 59%; CDR\u00a02\u20133: 77%; P\u2009&amp;lt;\u2009.001). Delirium was associated with higher 90-day mortality (adjusted HR\u2009=\u20093.45; 95% CI\u2009=\u20092.83\u20134.20). The relative association with mortality was greatest in no dementia and attenuated in moderate\u2013severe dementia. At 90\u00a0days, cumulative mortality was 54% with delirium vs. 15% without in CDR\u00a00 (HR\u2009=\u20094.40; 95% CI\u2009=\u20093.15\u20136.16) and 36% vs. 17% in CDR\u00a02\u20133 (HR\u2009=\u20092.22; 95% CI\u2009=\u20091.34\u20133.66). Patients with delirium also experienced more in-hospital complications (nosocomial infection, functional decline and prolonged stay).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although delirium was more frequent among patients with dementia, its relative association with 90-day mortality was strongest in those with no baseline dementia. The results provide a strong rationale for intervention trials to determine whether delirium prevention and management strategies can reduce mortality, particularly among patients without known dementia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag081","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:47:27Z","timestamp":1774010847000},"source":"Crossref","is-referenced-by-count":6,"title":["Frequent in dementia, deadliest without it: delirium and mortality in hospitalised older adults"],"prefix":"10.1093","volume":"55","author":[{"given":"Mfon","family":"Umoh","sequence":"first","affiliation":[{"name":"Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine , Baltimore, MD 21224 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9347-0519","authenticated-orcid":false,"given":"Thiago J","family":"Avelino-Silva","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California San Francisco , San Francisco, CA 94143 ,","place":["USA"]},{"name":"Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo , S\u00e3o Paulo, SP, 05403-000 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7467-1745","authenticated-orcid":false,"given":"Marlon Juliano Romero","family":"Aliberti","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo , S\u00e3o Paulo, SP, 05403-000 ,","place":["Brazil"]},{"name":"Research Institute, Hospital Sirio-Libanes , S\u00e3o Paulo, SP, 01308-060 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6111-9521","authenticated-orcid":false,"given":"Flavia Barreto","family":"Garcez","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, Universidade Federal de Sergipe Hospital Universitario , Aracaju, SE, 49060-025 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sei J","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California San Francisco , San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander K","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California San Francisco , San Francisco, CA 94143 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