Nurse Practitioner Program, University of Arizona, Tucson, AZ 85721-0203, USA.
Nurs Res. 2010 Sep-Oct;59(5):322-30. doi: 10.1097/NNR.0b013e3181ec156b.
Delirium is a state of acute confusion and is common in hospitalized older adults. Risk factors for delirium have been described; however, less clearly defined are the pathophysiological mechanisms that lead to the development of delirium.
The purpose of this study was to investigate the relationship of allostatic load (AL), a cumulative measure of physiological dysregulation resulting from adaptation to acute and chronic stress, and delirium in the hospitalized older adult.
In this descriptive study, participants 65 years and older admitted to the hospital were included. Participants were excluded if they had severe cognitive dysfunction or had prevalent delirium. Ten parameters reflecting physiological activity across a range of regulatory systems were measured on admission. Separate scores were calculated for primary mediators and secondary outcomes, subsets of overall AL. Incident delirium was assessed 48 to 72 hours after admission.
Mean age was 75.7 years (range = 66 to 93 years). The incidence of delirium was 29%. The AL score derived from primary mediators, urinary cortisol, epinephrine and norepinephrine, and serum dehydroepiandrosterone sulfate predicted the incidence of delirium (odds ratio = 2.54, 95% confidence interval = 1.12-5.79, p < .05). The overall AL score, the score derived from secondary outcomes, and the individual AL measures were not related significantly to the incidence of delirium.
AL has been shown to be an important construct in the early identification of physiological dysfunction related to exposure to psychosocial and environmental stress. The findings from this study suggest that AL, particularly the primary mediators score, may be a useful measure in determining delirium risk in hospitalized older adults, leading to improved surveillance and prevention of delirium. A better understanding of AL may lead to interventions focused on reducing the impact of AL on the older adult's physiological function.
谵妄是一种急性意识混乱状态，在住院的老年人中很常见。已经描述了谵妄的危险因素；然而，导致谵妄发展的病理生理机制定义得不太清楚。
本研究旨在调查全身适应综合征（AL），即适应急性和慢性应激导致的生理失调的累积衡量标准，与住院老年患者谵妄之间的关系。
在这项描述性研究中，纳入了 65 岁及以上住院的患者。如果患者有严重认知功能障碍或有明显的谵妄，则将其排除在外。在入院时测量了反映一系列调节系统生理活动的 10 个参数。分别计算了整体 AL 的主要介质和次要结果的分数。谵妄在入院后 48 至 72 小时进行评估。
平均年龄为 75.7 岁（范围为 66 岁至 93 岁）。谵妄的发生率为 29%。源于主要介质（尿皮质醇、肾上腺素和去甲肾上腺素）和血清脱氢表雄酮硫酸盐的 AL 评分预测了谵妄的发生率（比值比=2.54，95%置信区间=1.12-5.79，p<0.05）。整体 AL 评分、源于次要结果的评分以及个体 AL 测量值与谵妄的发生率无显著相关性。
AL 已被证明是识别与心理社会和环境压力暴露相关的生理功能障碍的重要指标。本研究的结果表明，AL，特别是主要介质评分，可能是确定住院老年患者谵妄风险的有用指标，从而改善对谵妄的监测和预防。对 AL 的更好理解可能会导致侧重于减少 AL 对老年患者生理功能影响的干预措施。
