Kiely Dan K, Bergmann Margaret A, Jones Richard N, Murphy Katharine M, Orav E John, Marcantonio Edward R
Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, Massachusetts 02131, USA.
J Gerontol A Biol Sci Med Sci. 2004 Apr;59(4):344-9. doi: 10.1093/gerona/59.4.m344.
Delirium is costly, common, and may persist for weeks or months. Therefore, the adverse impact of delirium on loss of independence may occur in the post-acute setting rather than in the hospital. The purpose of this study is to describe the rate of delirium persistence and identify baseline patient characteristics that are associated with delirium persistence at 1 month among newly admitted post-acute facility patients who were admitted with delirium.
Patients were recruited from 4 Boston area skilled nursing facilities specializing in post-acute care (PAC). Assessment instruments included the Confusion Assessment Method Diagnostic Algorithm, the modified Delirium Symptom Interview, the Memorial Delirium Assessment Scale (MDAS), and the Blessed Dementia Rating Scale (BDRS). Multiple logistic regression analyses were used to identify patient characteristics associated with delirium persistence (at 1 month).
Nearly 51% of the 85 delirious patients enrolled in this study had delirium at their 1-month follow-up assessment. Four patient factors associated with delirium persistence were identified: older age (> or =85 years), severe delirium at PAC admission (MDAS score >15), prehospital cognitive impairment based on proxy report [BDRS], and the presence of all 8 modified Delirium Symptom Interview symptoms at PAC admission. Our model has very good predictive power (area under the receiver operating characteristic = 0.85).
Delirium is persistent in the post-acute setting. If verified in further research, the risk factors found in this study could be used to identify patients who are likely to have delirium after 1 month, and may prove useful in developing and targeting interventions of care.
谵妄代价高昂且很常见，可能持续数周或数月。因此，谵妄对独立能力丧失的不利影响可能发生在急性后期环境而非医院。本研究的目的是描述谵妄持续的发生率，并确定在急性后期设施新入院且伴有谵妄的患者中，与1个月时谵妄持续相关的基线患者特征。
从波士顿地区4家专门从事急性后期护理（PAC）的熟练护理机构招募患者。评估工具包括意识模糊评估方法诊断算法、改良的谵妄症状访谈、纪念谵妄评估量表（MDAS）和Blessed痴呆评定量表（BDRS）。采用多元逻辑回归分析来确定与谵妄持续（1个月时）相关的患者特征。
本研究纳入的85例谵妄患者中，近51%在1个月的随访评估时仍有谵妄。确定了与谵妄持续相关的4个患者因素：年龄较大（≥85岁）、PAC入院时严重谵妄（MDAS评分>15）、基于代理报告的院前认知障碍[BDRS]以及PAC入院时存在所有8种改良的谵妄症状访谈症状。我们的模型具有很好的预测能力（受试者工作特征曲线下面积 = 0.85）。
谵妄在急性后期环境中持续存在。如果在进一步研究中得到验证，本研究中发现的危险因素可用于识别可能在1个月后仍有谵妄的患者，并可能在制定和针对性护理干预方面证明有用。
