Francis J, Kapoor W N
Section of Geriatrics and Extended Care, Department of Veterans Affairs Medical Center, Memphis, Tennessee.
J Am Geriatr Soc. 1992 Jun;40(6):601-6. doi: 10.1111/j.1532-5415.1992.tb02111.x.
To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium.
Descriptive cohort study.
General medical wards of a teaching hospital.
Two hundred twenty-nine consecutive patients aged 70 years or older who had been community-dwelling prior to admission. Fifty patients met criteria for delirium (cases); these were compared to patients without delirium (controls). Two-hundred twenty-three patients survived hospitalization (46 cases, 177 controls) Of these, 92% were followed greater than or equal to 2 years.
Vital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or care-givers 2 years after discharge. Independent community living was defined as survivorship outside of an institution and without dependence in any of four basic ADL (bathing, dressing, transfers, eating).
Two-year mortality in the entire population was 39% for cases and 23% for controls (relative risk 1.82, 95% confidence interval 1.04-3.19). Delirium identified those patients at risk for loss of independent community living, even after adjustment for potential confounding variables (adjusted odds ratio 2.56, 95% confidence interval 1.10-5.91). Follow-up cognitive testing in a subset of patients with high baseline performance revealed a greater decline in performance among cases of delirium than controls (P = 0.023).
Delirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.
确定老年患者谵妄发作2年后的生存率、功能独立性和认知表现。
描述性队列研究。
一家教学医院的普通内科病房。
229例连续入院的70岁及以上患者，入院前居住在社区。50例符合谵妄标准（病例组）；将这些患者与无谵妄的患者（对照组）进行比较。223例患者存活出院（46例病例组，177例对照组）。其中，92%的患者随访时间大于或等于2年。
出院2年后通过电话访谈患者或护理人员确定生命状态、居住地点、日常生活活动能力（ADL）和认知表现。独立社区生活定义为在机构外存活且在四项基本ADL（洗澡、穿衣、转移、进食）中任何一项均无依赖。
病例组的全人群2年死亡率为39%，对照组为23%（相对风险1.82，95%置信区间1.04 - 3.19）。即使在对潜在混杂变量进行调整后，谵妄仍可识别出有失去独立社区生活风险的患者（调整后的优势比2.56，95%置信区间1.10 - 5.91）。对基线表现较高的部分患者进行的随访认知测试显示，谵妄病例组的表现下降幅度大于对照组（P = 0.023）。
谵妄可识别出有死亡或失去独立性风险的老年患者。谵妄还可能识别出有未来认知能力下降风险的患者。
