Kiely Dan K, Jones Richard N, Bergmann Margaret A, Marcantonio Edward R
Hebrew SeniorLife, Institute for Aging Research, Boston, MA 02131, USA.
J Gerontol A Biol Sci Med Sci. 2007 Feb;62(2):174-9. doi: 10.1093/gerona/62.2.174.
Delirium is common among hospitalized elders and may persist for months. Therefore, the adverse impact of delirium on independence often occurs in the post acute care (PAC) setting. The effect of psychomotor subtypes on delirium remains uncertain. The purpose of this study is to examine the association between psychomotor activity delirium subtypes and 1-year mortality among 457 newly admitted delirious PAC patients.
Patients were screened for delirium on admission to PAC facilities after an acute hospitalization, and patients with "Confusion Assessment Method"-defined delirium were enrolled. Psychomotor activity was assessed using the Memorial Delirium Assessment Scale, and patients were classified as to their delirium subtype (hyperactive, hypoactive, mixed, or normal). One-year mortality data were obtained from the National Death Index. A Kaplan-Meier survival analysis and a proportional hazards analysis using indicator (dummy) variables with normal psychomotor activity as the referent were performed.
The normal psychomotor activity group had the lowest 1-year mortality rate, followed by the hyperactive, mixed, then hypoactive groups in increasing order. Independent of age, gender, comorbidity, dementia, and delirium severity, hypoactive patients were 1.60 (95% confidence interval [CI], 1.09-2.35) times more likely to die during the 1-year follow-up period than were patients with normal psychomotor activity. The hyperactive (hazard ratio = 1.30; 95% CI, 0.73-2.31) and mixed (hazard ratio = 1.25; 95% CI, 0.72-2.17) psychomotor groups had nonsignificant elevated risks relative to the normal psychomotor behavior group.
All three psychomotor disturbance subtypes had an elevated risk of dying during the 1-year follow-up relative to the normal psychomotor group, though the hypoactive group had the highest mortality risk and was the only group with a statistically significantly elevated risk relative to the normal group.
谵妄在住院老年人中很常见，且可能持续数月。因此，谵妄对独立性的不利影响通常发生在急性后护理（PAC）环境中。精神运动亚型对谵妄的影响仍不确定。本研究的目的是探讨457名新入院的谵妄PAC患者中精神运动活动谵妄亚型与1年死亡率之间的关联。
急性住院后，患者在进入PAC设施时接受谵妄筛查，纳入符合“意识错乱评估方法”定义的谵妄患者。使用纪念性谵妄评估量表评估精神运动活动，并将患者按谵妄亚型（多动型、少动型、混合型或正常型）进行分类。从国家死亡指数获取1年死亡率数据。进行了Kaplan-Meier生存分析以及以正常精神运动活动为参照的使用指示（虚拟）变量的比例风险分析。
正常精神运动活动组的1年死亡率最低，其次是多动型、混合型，然后是少动型组，且风险依次增加。独立于年龄、性别、合并症、痴呆和谵妄严重程度，少动型患者在1年随访期内死亡的可能性是精神运动活动正常患者的1.60倍（95%置信区间[CI]，1.09 - 2.35）。多动型（风险比 = 1.30；95% CI，0.73 - 2.31）和混合型（风险比 = 1.25；95% CI，0.72 - 2.17）精神运动组相对于正常精神运动行为组的风险虽有升高但无统计学意义。
相对于正常精神运动组，所有三种精神运动障碍亚型在1年随访期间死亡风险均升高，尽管少动型组的死亡风险最高，且是唯一相对于正常组有统计学显著升高风险的组。
