Visual impairment predicts delirium risk

Visual impairment roughly doubled hospitalized adults’ odds of delirium.
*Systematic review/meta-analysis of observational studies; Level 2 (OCEBM).

Citation

Abu Osba A, Bondok M, Ibrahim A, et al. The Association Between Visual Impairment and Delirium: A Systematic Review and Meta-Analysis. J Gen Intern Med. 2026. doi:10.1007/s11606-026-10804-w

Background

Delirium is common in hospitalized adults and is linked to worse outcomes. Visual impairment is frequent in older adults, but its role as a delirium risk marker has been uncertain.

Patients

Adults aged 18 years or older in 44 studies, totaling 26,230 participants across varied clinical settings. Excluded: pediatric, non-human, case reports with 5 or fewer participants, reviews, conference abstracts, and studies missing delirium or visual impairment data.

Intervention

Presence of visual impairment, defined variably across studies.

Control

No visual impairment.

Outcome

Delirium, assessed using clinical tools, chart review, or diagnostic criteria.

Follow-up Period

During hospitalization or acute care encounter.

Results

Analysis Studies Association with delirium
Primary: adjusted estimates 16 OR 2.02 (95% CI 1.29 to 3.16)
Secondary: all unadjusted estimates 44 OR 2.40 (95% CI 1.81 to 3.18)
Adjusted stroke subgroup Not reported OR 3.07 (95% CI 1.92 to 4.90)
Adjusted general medicine subgroup Not reported OR 2.06 (95% CI 1.47 to 2.88)

OR = odds ratio; CI = confidence interval.

Evidence certainty was rated low. The study addressed prognosis, not whether treating vision problems prevents delirium.

Limitations

All included studies were observational, so causation cannot be established. Definitions of visual impairment and delirium varied widely. Adjustment for other delirium risks, such as dementia, frailty, illness severity, hearing loss, and medications, was inconsistent. Heterogeneity was substantial.

Funding

No specific funding; authors reported no competing interests.

Clinical Application

Screen hospitalized adults with vision problems as higher delirium risk; ensure glasses, lighting, orientation, and closer monitoring, without assuming vision correction prevents delirium.