Center for Hospice and Palliative Care, Cheektowaga, New York 14227, USA.
J Palliat Med. 2013 Jul;16(7):768-73. doi: 10.1089/jpm.2012.0561. Epub 2013 May 29.
Delirium is one of the most distressing and difficult to manage problems in advanced illness. Family caregivers have a unique view of the progression of delirium.
This study examined precursors to delirium from the perspective of family caregivers.
This study utilized a two-stage concept mapping design that began with semistructured interviews with caregivers of patients suffering with delirium. The interview data was sorted and rated by clinicians prior to quantitative data analysis via multidimensional scaling (MDS) and cluster analysis.
SUBJECTS/SETTINGS: The subjects were 20 family caregivers of patients with a diagnosis of delirium in a hospice inpatient unit.
The main outcome of the study was a multidimensional model of precursors of delirium that included 99 specific items. The model included ten clusters within three general domains: Cognition, Distress, and Rest/Sleep. An exploratory analysis suggested that Rest and Sleep issues were evident to caregivers much earlier than other kinds of problems (mean=17.56 weeks prior to hospice admission, 95% CI=9.2-25.0 weeks).
This study provides detailed insights from family caregivers about the progression of delirium. The caregiver observations were clustered by multivariate analysis to provide a map of symptom domains. The principal finding of this study is that sleep disturbance was identified by almost all family caregivers much earlier than other more commonly recognized symptoms associated with delirium. The study highlights the importance of sleep fragmentation in the temporal progression of delirium and points toward opportunities for improved measurement, prevention, and treatment.
谵妄是晚期疾病中最令人痛苦和难以管理的问题之一。家庭照顾者对谵妄的进展有独特的看法。
本研究从家庭照顾者的角度探讨谵妄的前驱症状。
本研究采用两阶段概念映射设计，首先对患有谵妄的患者的家庭照顾者进行半结构化访谈。在通过多维标度（MDS）和聚类分析进行定量数据分析之前，临床医生对访谈数据进行分类和评分。
研究对象/地点：研究对象为 20 名在临终关怀住院病房被诊断为谵妄的患者的家庭照顾者。
该研究的主要结果是一个包括 99 个特定项目的谵妄前驱症状多维模型。该模型包括三个一般领域内的十个聚类：认知、痛苦和休息/睡眠。探索性分析表明，照顾者很早就注意到休息和睡眠问题（入住临终关怀前平均 17.56 周，95%CI=9.2-25.0 周）。
本研究从家庭照顾者那里详细了解了谵妄的进展情况。通过多元分析对照顾者的观察结果进行聚类，提供了一个症状域的图谱。本研究的主要发现是，睡眠障碍几乎被所有家庭照顾者更早地识别出来，而其他与谵妄相关的更常见症状则较晚识别出来。该研究强调了睡眠中断在谵妄时间进程中的重要性，并指出了改善测量、预防和治疗的机会。
