Division of Geriatric Medicine, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Geriatr Gerontol Int. 2013 Oct;13(4):972-7. doi: 10.1111/ggi.12041. Epub 2013 Mar 3.
Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes--length of stay (LOS), in-hospital mortality and 3-month mortality--among delirious Thai older patients.
A prospective observational study was carried out in a university hospital in Thailand. All patients aged older than 70 years admitted to general medical wards were included. Delirium assessments were undertaken within the first 24 h of admission and serially until discharge. Subsequent assessments were carried out at 3 months after discharge. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Factors associated with mortality were determined by using logistic regression models.
LOS was significantly longer in the delirium group (10 and 8 days, P = 0.001). Furthermore, the delirium group had higher in-hospital and 3-month mortality (P < 0.001). Factors significantly associated with in-hospital mortality in multivariate analysis were age more than 80 years (AOR 2.74, 95% CI 1.05-7.15), malignancy (AOR 3.11, 95% CI 1.16-8.33), severe illness (AOR 3.75, 95% CI 1.38-10.20) and delirium (AOR 7.34, 95% CI 1.51-35.69). Delirium remained a strong predictor for 3-month mortality in multivariate analysis with AOR of 3.33 (95% CI 1.45-7.62) CONCLUSIONS: Delirium was associated with prolonged hospital-stay and was the strongest predictor for mortality among older hospitalized patients. It requires serious attention from physicians, healthcare administrators and policy makers to implement an appropriate management plan for this high-burden issue.
谵妄是住院老年患者中常见的一种紊乱，常常导致不良后果。先前在不同环境下进行的研究对临床结局和死亡率提供了相互矛盾的结果。我们旨在研究泰国老年住院患者中三种临床结局——住院时间（LOS）、住院内死亡率和 3 个月死亡率。
在泰国的一所大学医院进行了一项前瞻性观察性研究。所有年龄大于 70 岁并被收入普通内科病房的患者都被纳入研究。在入院的头 24 小时内并在出院前进行多次谵妄评估。随后在出院后 3 个月进行评估。根据《精神障碍诊断与统计手册》第四版标准诊断谵妄。使用逻辑回归模型确定与死亡率相关的因素。
谵妄组的 LOS 明显更长（10 天和 8 天，P=0.001）。此外，谵妄组的住院内和 3 个月死亡率更高（P<0.001）。多变量分析中与住院内死亡率显著相关的因素是年龄大于 80 岁（AOR 2.74，95%CI 1.05-7.15）、恶性肿瘤（AOR 3.11，95%CI 1.16-8.33）、严重疾病（AOR 3.75，95%CI 1.38-10.20）和谵妄（AOR 7.34，95%CI 1.51-35.69）。在多变量分析中，谵妄仍然是 3 个月死亡率的强有力预测因素，AOR 为 3.33（95%CI 1.45-7.62）。
谵妄与住院时间延长有关，是老年住院患者死亡的最强预测因素。它需要医生、医疗保健管理人员和政策制定者认真关注，为这一高负担问题实施适当的管理计划。
