Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
J Hosp Med. 2013 Jun;8(6):321-7. doi: 10.1002/jhm.2035. Epub 2013 Mar 29.
Patients with delirium, especially when superimposed on dementia, are at high risk of functional decline.
To examine the influence of a multicomponent delirium management program, the geriatric monitoring unit (GMU), on functional progress of delirious older patients and the impact of underlying dementia on functional recovery.
Prospective cohort study.
The GMU is a specialized 5-bed unit for the care of delirious older adults within an acute tertiary hospital.
Patients aged 65 years and older with delirium.
The GMU is a multifactorial delirium treatment program with core interventions focusing on early mobilization and rehabilitation.
Baseline measures included delirium severity (Delirium Rating Scale-98 and Confusion Assessment Method severity), Chinese Mini-Mental State Examination, functional status (modified Barthel Index [MBI]), comorbidity (Charlson's), and illness severity (modified Severity of Illness Index). Patients with and without dementia were compared for recovery in cognitive scores and functional status.
Of 122 patients with delirium who were admitted to the GMU over a 1-year period, 82 (67.2%) had underlying dementia. There were no significant differences in age, gender, delirium severity, illness severity, cognitive performance, and functional status at admission to the GMU between groups, although patients with dementia had significantly higher comorbidity (Charlson's 2.27 vs 1.75, P = 0.05). Significant cognitive and functional improvement was observed for the entire GMU cohort, with demented and nondemented groups capable of functional recovery (MBI gain of 20.43 vs 17.35, respectively, P = 0.35).
Elderly patients with dementia recovering from delirium have comparable potential for functional recovery as their cognitively intact counterparts in a delirium management unit focused on geriatric nursing care and rehabilitation.
患有谵妄的患者，尤其是并发痴呆的患者，其功能下降的风险较高。
研究多组分谵妄管理方案（老年监测单元，GMU）对老年谵妄患者的功能进展的影响，以及潜在痴呆对功能恢复的影响。
前瞻性队列研究。
GMU 是一家急性三级医院内专门用于护理老年谵妄患者的 5 床单元。
年龄在 65 岁及以上、患有谵妄的患者。
GMU 是一种多因素谵妄治疗方案，其核心干预措施侧重于早期活动和康复。
基线测量包括谵妄严重程度（谵妄评定量表-98 分和意识模糊评估方法严重程度）、简易智力状态检查、功能状态（改良巴氏指数）、合并症（Charlson 合并症指数）和疾病严重程度（改良疾病严重程度指数）。比较有和无痴呆的患者在认知评分和功能状态方面的恢复情况。
在为期 1 年的时间里，GMU 共收治了 122 例患有谵妄的患者，其中 82 例（67.2%）患有潜在痴呆。两组患者在入住 GMU 时的年龄、性别、谵妄严重程度、疾病严重程度、认知表现和功能状态无显著差异，尽管痴呆患者的合并症明显更高（Charlson 合并症指数 2.27 比 1.75，P=0.05）。整个 GMU 队列均观察到显著的认知和功能改善，痴呆和非痴呆组均具有功能恢复的能力（改良巴氏指数的增益分别为 20.43 和 17.35，P=0.35）。
在以老年护理和康复为重点的谵妄管理单元中，从谵妄中恢复的痴呆老年患者在功能恢复方面与认知功能正常的患者具有相当的潜力。
