Department of Geriatric Medicine, Cardiff University, Academic Centre, University Hospital Llandough, Penarth, South Wales, UK.
Age Ageing. 2010 Jul;39(4):470-5. doi: 10.1093/ageing/afq052.
Delirium is a disorder affecting consciousness, which gives rise to core clinical features and associated symptoms. Older patients are particularly prone, owing to higher rates of pre-existing cognitive impairment, frailty, co-morbidity and polypharmacy.
The aim of this study was to investigate the hypotheses that delirium affects the most vulnerable older adults and is associated with long-term adverse health outcome.
This prospective cohort study evaluated 278 medical patients aged > or = 75 years admitted acutely to a district general hospital in South Wales. Patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Assessments also included illness severity, preadmission cognition, co-morbidity and functional status. Patients were followed for 5 years to determine rates of institutionalisation and mortality. Number of days in hospital in the 4 years prior to and 5 years after index admission were recorded.
Delirium was detected in 103 patients and excluded in 175. Median time to death was 162 days (interquartile range 21-556) for those with delirium compared with 1,444 days (25% mortality 435 days, 75% mortality>5 years) for those without (P < 0.001). After adjusting for multiple confounders, delirium was associated with an increased risk of death (hazard ratio range 2.0-3.5; P < or = 0.002). Institutionalisation was higher in the first year following delirium (P = 0.03). While those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity, they did not spend more days in hospital in the 4 years prior to index admission.
Delirium is associated with high rates of institutionalisation and an increased risk of death up to 5 years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome.
谵妄是一种影响意识的疾病，其导致核心临床特征和相关症状。由于认知障碍、虚弱、合并症和多种药物治疗的发生率较高，老年患者尤其容易出现这种情况。
本研究旨在验证以下两个假设，即谵妄影响最脆弱的老年患者，并与长期不良健康结局相关。
本前瞻性队列研究评估了 278 名年龄≥75 岁的入住南威尔士地区综合医院的急性内科患者。在入院时和住院期间的每隔一天对患者进行谵妄筛查。评估还包括疾病严重程度、入院前认知功能、合并症和功能状态。对患者进行了 5 年的随访，以确定其住院和死亡的发生率。记录患者在指数入院前 4 年和后 5 年住院的天数。
103 名患者被诊断为谵妄，175 名患者被排除在外。与无谵妄患者（25%的死亡率为 435 天，75%的死亡率>5 年）相比，有谵妄的患者中位死亡时间为 162 天（四分位距 21-556）（P<0.001）。在校正了多个混杂因素后，谵妄与死亡风险增加相关（风险比范围 2.0-3.5；P<0.002）。谵妄后第一年的入院率更高（P=0.03）。尽管谵妄患者年龄较大，入院前认知功能障碍更多，功能依赖性更大，合并症更多，但他们在指数入院前 4 年住院天数并没有增加。
谵妄与高入院率和指数事件后 5 年内死亡风险增加相关。在发生谵妄之前，个体似乎会对其脆弱性做出补偿。谵妄本身直接或间接的影响可能会将脆弱性转化为不良结局。
