Rhodius-Meester H F M, van Campen J P C M, Fung W, Meagher D J, van Munster B C, de Jonghe J F M
Slotervaart Ziekenhuis, Amsterdam, The Netherlands.
Tijdschr Gerontol Geriatr. 2013 Oct;44(5):206-14. doi: 10.1007/s12439-013-0028-2.
Delirium is common in older patients admitted to hospital. Information obtained from patient's relatives or caregivers may contribute to improved detection. Our aim was to develop a caregiver based questionnaire, the Informant Assessment of Geriatric Delirium (I-AGeD), to assist in better recognition of delirium in elderly patients.
A cross-sectional observational study using a scale construction patient cohort and two validation cohorts was conducted at geriatric departments of two teaching hospitals in The Netherlands. Delirium status, based on DSM-IV criteria, was assessed directly on admission by a geriatric resident and evaluated within the first 48 h of admission. Caregivers filled out a 37-item questionnaire of which 10 items were selected reflecting delirium symptoms, based on their discriminatory abilities, internal consistency and inter-item correlations.
A total of 88 patients with complete study protocols in the construction cohort were included. Average age was 86.4 (SD 8.5), and 31/88 patients had delirium on admission. Internal consistency of the 10-item I-AGeD was high (Cronbach's alpha = 0.85). At a cut-off score of >4 sensitivity was 77.4% and specificity 63.2%. In patients without dementia, sensitivity was 100% and specificity 65.2%. Validation occurred by means of two validation cohorts, one consisted of 59 patients and the other of 33 patients. Sensitivity and specificity in these samples ranged from 70.0% to 88.9% and 66.7% to 100%, respectively.
The newly constructed caregiver based I-AGeD questionnaire is a valid screening instrument for delirium on admission to hospital in geriatric patients.
谵妄在老年住院患者中很常见。从患者亲属或照护者处获取的信息可能有助于提高识别率。我们的目的是开发一种基于照护者的问卷，即老年谵妄照护者评估问卷（I-AGeD），以协助更好地识别老年患者的谵妄。
在荷兰两家教学医院的老年科进行了一项横断面观察性研究，使用量表构建患者队列和两个验证队列。根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准，由老年科住院医师在入院时直接评估谵妄状态，并在入院后的48小时内进行评估。照护者填写一份包含37个条目的问卷，根据其区分能力、内部一致性和条目间相关性，从中选择了10个反映谵妄症状的条目。
构建队列中共有88例完成研究方案的患者纳入研究。平均年龄为86.4岁（标准差8.5），31/88例患者入院时存在谵妄。10条目I-AGeD的内部一致性较高（克朗巴赫α系数=0.85）。在临界值>4分时，敏感性为77.4%，特异性为63.2%。在无痴呆的患者中，敏感性为100%，特异性为65.2%。通过两个验证队列进行验证，一个队列包含59例患者，另一个队列包含33例患者。这些样本中的敏感性和特异性分别为70.0%至88.9%和66.7%至100%。
新构建的基于照护者的I-AGeD问卷是老年患者入院时谵妄的有效筛查工具。
