Gentric A, Le Deun P, Estivin S
Service de médecine interne gériatrique, CHU La Cavale-Blanche, 29285 Brest, France.
Rev Med Interne. 2007 Sep;28(9):589-93. doi: 10.1016/j.revmed.2007.04.004. Epub 2007 May 15.
Delirium is the most common complication of hospitalization in frail elderly. The prognosis is poor with increased mortality and morbidity. Confusion results from one or several precipitating factors in patients at risk. In a randomized study, a preventive multicomponent intervention reduced the incidence of delirium by 40%. The aim of our study was to evaluate the efficacy of such a preventive strategy, in the setting of an acute geriatric care unit.
The study was conducted in a French 26-bed geriatric acute care ward. The primary outcome was the comparison of the incidence of delirium among patients aged 75 years and older, before and after the implementation of a preventive strategy. The overall adherence of the ward staff to the prevention procedures was also determined.
Before intervention, 367 patients were admitted (mean age: 80.6 years). The incidence of delirium was of 8.99%. In the subgroup of 123 demented patients, the incidence of delirium was of 15.4%. After intervention, 372 patients were admitted (mean age 84.9). The incidence of delirium was of 2.4% (relative risk reduction of 73%, P=0.001). In the subgroup of 133 demented patients, the incidence of delirium was 5.3% (relative risk reduction of 66%, P=0.01). The ward staff applied the prevention procedures in 96% of the 10 230 patients-day during the study period.
This study shows that it is possible to apply the results of clinical research in clinical practice to prevent delirium in frail elderly hospitalized in an acute geriatric care unit. Such an easy preventive strategy could be applied in medical units admitting old patients at risk, in the context of a quality procedure.
谵妄是体弱老年人住院最常见的并发症。其预后较差，死亡率和发病率均有所增加。意识混乱是由高危患者中的一个或几个诱发因素导致的。在一项随机研究中，一种预防性多组分干预措施使谵妄的发生率降低了40%。我们研究的目的是在急性老年护理病房环境中评估这种预防策略的效果。
该研究在法国一个有26张床位的老年急性护理病房进行。主要结局是比较75岁及以上患者在实施预防策略前后谵妄的发生率。同时还确定了病房工作人员对预防程序的总体依从性。
干预前，收治了367例患者（平均年龄：80.6岁）。谵妄发生率为8.99%。在123例痴呆患者亚组中，谵妄发生率为15.4%。干预后，收治了372例患者（平均年龄84.9岁）。谵妄发生率为2.4%（相对风险降低73%，P = 0.001）。在133例痴呆患者亚组中，谵妄发生率为5.3%（相对风险降低66%，P = 0.01）。在研究期间，病房工作人员在10230个患者日中的96%应用了预防程序。
本研究表明，在急性老年护理病房住院的体弱老年人中，将临床研究结果应用于临床实践以预防谵妄是可行的。在质量程序的背景下，这种简单的预防策略可应用于收治高危老年患者的医疗单位。
