University of New England College of Osteopathic Medicine, Biddeford, Maine, USA.
J Am Geriatr Soc. 2012 Jun;60(6):1122-7. doi: 10.1111/j.1532-5415.2012.03958.x. Epub 2012 May 30.
To investigate whether complications in postacute care (PAC) are associated with delirium persistence 30 days after PAC admission.
Observational cohort study.
Eight Boston-area PAC facilities.
Three hundred fifty individuals with delirium at PAC admission.
Participants were interviewed at PAC admission and 30 days later. Delirium presence was determined using the Confusion Assessment Method. Medical record reviews were performed to ascertain new cardiac, noncardiac, and geriatric syndrome complications in PAC. Complication status was also determined 30 days after admission or at PAC discharge, whichever came first.
Participants (mean age 83.6, 66% female) experienced the following incidence of PAC complications: cardiac complications (7%), noncardiac complications (21%), and geriatric syndrome complications (39%). Delirium persisted in 56% of participants 1 month after PAC admission. Neither cardiac nor noncardiac complications were associated with delirium persistence. Delirium persistence at 1 month was significantly greater in participants, with more geriatric syndrome complications (no complications, 51%; one complication 61%; ≥ 2 complications, 100%, adjusted P = .048). There was also a trend toward greater delirium persistence in participants with unresolved geriatric syndrome complications (no complications, 51%; resolved complication, 61%; unresolved complication, 68%; adjusted P = .10).
Geriatric syndrome complications are common in individuals admitted to PAC with delirium and are associated with persistence of delirium 1 month later. Proactively addressing risk factors for geriatric syndromes may improve outcomes of vulnerable individuals in PAC.
调查急性后期护理（PAC）中的并发症是否与 PAC 入院后 30 天持续性谵妄有关。
观察性队列研究。
波士顿地区的 8 个 PAC 设施。
350 名 PAC 入院时患有谵妄的个体。
参与者在 PAC 入院时和 30 天后接受访谈。使用意识混乱评估方法确定谵妄的存在。进行病历回顾以确定 PAC 中出现新的心脏、非心脏和老年综合征并发症。并发症状态也在入院后 30 天或 PAC 出院时确定，以先到者为准。
参与者（平均年龄 83.6 岁，66%为女性）经历了以下 PAC 并发症的发生率：心脏并发症（7%）、非心脏并发症（21%）和老年综合征并发症（39%）。56%的参与者在 PAC 入院后 1 个月仍存在谵妄。心脏和非心脏并发症均与谵妄持续无关。有更多老年综合征并发症的参与者 1 个月时的谵妄持续时间明显更长（无并发症者为 51%；有 1 种并发症者为 61%；有≥2 种并发症者为 100%，调整后 P=0.048）。有未解决老年综合征并发症的参与者的谵妄持续时间也呈增加趋势（无并发症者为 51%；已解决并发症者为 61%；未解决并发症者为 68%，调整后 P=0.10）。
患有谵妄而入院到 PAC 的个体中常见老年综合征并发症，并且与 1 个月后谵妄持续有关。积极处理老年综合征的危险因素可能会改善 PAC 中脆弱个体的预后。
