Voyer Philippe, McCusker Jane, Cole Martin G, St-Jacques Sylvie, Khomenko Lioudmila
Faculty of Nursing Sciences, Laval University, Québec, QC, Canada.
J Clin Nurs. 2007 May;16(5):819-31. doi: 10.1111/j.1365-2702.2006.01808.x.
The goal of this study was to determine whether the factors associated with delirium varied according to the severity of the delirium experienced by the older patients.
Delirium among older patients is prevalent and leads to numerous detrimental effects. The negative consequences of delirium are worse among older adults with severe delirium compared with patients with mild delirium. There has been no study identifying those factors associated with delirium severity among long-term care older patients newly admitted to an acute care hospital.
This is a descriptive study.
This is a secondary analysis study of institutionalized older patients newly admitted to an acute care hospital (n = 104). Upon admission, patients were screened for delirium with the Confusion Assessment Method and severity of delirium symptoms were determined by using the Delirium Index.
Of the 71 delirious older patients, 32 (45.1%) had moderate-severe delirium while 39 (54.9%) presented mild delirium. In univariate analyses, a significant positive relationship was observed between the level of prior cognitive impairment and the severity of delirium (p = 0.0058). Low mini-mental state examination (MMSE) scores (p < 0.0001), the presence of severe illness at the time of hospitalization (p = 0.0016) and low functional autonomy (BI: p = 0.0017; instrumental activities of daily living: p = 0.0003) were significantly associated with moderate-severe delirium. Older patients suffering from mild delirium used significantly more drugs (p = 0.0056), notably narcotics (p = 0.0017), than those with moderate-severe delirium. Results from the stepwise regression indicated that MMSE score at admission and narcotic medication use are the factors most strongly associated with the severity of delirium symptoms.
This present study indicates that factors associated with moderate-severe delirium are different from those associated with mild delirium. Given the result concerning the role of narcotics, future studies should evaluate the role of pain management in the context of delirium severity.
As moderate-severe delirium is associated with poorer outcomes than is mild delirium, early risk factor identification for moderate-severe delirium by nurses may prove to be of value in preventing further deterioration of those older patients afflicted with delirium.
本研究的目的是确定与谵妄相关的因素是否因老年患者所经历的谵妄严重程度而异。
老年患者中的谵妄很常见，并会导致许多有害影响。与轻度谵妄患者相比，重度谵妄的老年人中谵妄的负面后果更严重。尚无研究确定新入住急性护理医院的长期护理老年患者中与谵妄严重程度相关的因素。
这是一项描述性研究。
这是一项对新入住急性护理医院的机构化老年患者（n = 104）的二次分析研究。入院时，使用混乱评估方法对患者进行谵妄筛查，并使用谵妄指数确定谵妄症状的严重程度。
在71名谵妄老年患者中，32名（45.1%）患有中度至重度谵妄，而39名（54.9%）表现为轻度谵妄。在单因素分析中，观察到先前认知障碍水平与谵妄严重程度之间存在显著正相关（p = 0.0058）。简易精神状态检查表（MMSE）得分低（p < 0.0001）、住院时存在严重疾病（p = 0.0016）和功能自主性低（巴氏指数：p = 0.0017；日常生活活动能力：p = 0.0003）与中度至重度谵妄显著相关。患有轻度谵妄的老年患者使用的药物明显更多（p = 0.0056），尤其是麻醉药品（p = 0.0017），比患有中度至重度谵妄的患者更多。逐步回归结果表明，入院时的MMSE得分和麻醉药物使用是与谵妄症状严重程度最密切相关的因素。
本研究表明，与中度至重度谵妄相关的因素与轻度谵妄相关的因素不同。鉴于麻醉药品作用的研究结果，未来的研究应评估疼痛管理在谵妄严重程度背景下的作用。
由于中度至重度谵妄比轻度谵妄的预后更差，护士对中度至重度谵妄的早期危险因素识别可能对预防那些患有谵妄的老年患者病情进一步恶化具有价值。
