Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.
Clin Interv Aging. 2014 Apr 8;9:603-12. doi: 10.2147/CIA.S60259. eCollection 2014.
Delirium is associated with poor outcomes following acute hospitalization. The Geriatric Monitoring Unit (GMU) is a specialized five-bedded unit for acute delirium care. It is modeled after the Delirium Room program, with adoption of core interventions from the Hospital Elder Life Program and use of evening light therapy to consolidate circadian rhythms and improve sleep in older inpatients. This study examined whether the GMU program improved outcomes in delirious patients.
A total of 320 patients, including 47 pre-GMU, 234 GMU, and 39 concurrent control subjects, were studied. Clinical characteristics, cognitive status, functional status (Modified Barthel Index [MBI]), and chemical restraint-use data were obtained. We also looked at in-hospital complications of falls, pressure ulcers, nosocomial infection rate, and discharge destination. Secondary outcomes of family satisfaction (for the GMU subjects) were collected.
There were no significant demographic differences between the three groups. Pre-GMU subjects had longer duration of delirium and length of stay. MBI improvement was most evident in the GMU compared with pre-GMU and control subjects (19.2±18.3, 7.5±11.2, 15.1±18.0, respectively) (P<0.05). The GMU subjects had a zero restraint rate, and pre-GMU subjects had higher antipsychotic dosages. This translated to lower pressure ulcer and nosocomial infection rate in the GMU (4.1% and 10.7%, respectively) and control (1.3% and 7.7%, respectively) subjects compared with the pre-GMU (9.1% and 23.4%, respectively) subjects (P<0.05). No differences were observed in mortality or discharge destination among the three groups. Caregivers of GMU subjects felt the multicomponent intervention to be useful, with scheduled activities voted the most beneficial in patient's recovery from the delirium episode.
This study shows the benefits of a specialized delirium management unit for older persons. The GMU model is thus a relevant system of care for rapidly "graying" nations with high rates of frail elderly hospital admissions, which can be easily transposed across acute care settings.
谵妄与急性住院后的不良预后有关。老年监测单元（GMU）是一个专门用于急性谵妄护理的五张床位单元。它是根据谵妄病房计划建立的，采用了医院老年生活计划的核心干预措施，并使用夜间光照疗法来巩固昼夜节律，改善老年住院患者的睡眠。本研究旨在探讨 GMU 方案是否改善了谵妄患者的结局。
共纳入 320 名患者，包括 47 名 GMU 前患者、234 名 GMU 患者和 39 名同期对照组患者。收集了临床特征、认知状态、功能状态（改良巴氏指数[MBI]）和化学约束使用数据。我们还观察了住院期间跌倒、压疮、医院感染率和出院去向的并发症。收集了 GMU 患者的家庭满意度（作为次要结局）。
三组患者的人口统计学差异无统计学意义。GMU 前患者的谵妄持续时间和住院时间较长。与 GMU 前和对照组患者相比，GMU 患者的 MBI 改善最为明显（19.2±18.3、7.5±11.2、15.1±18.0，分别）（P<0.05）。GMU 患者的约束率为零，GMU 前患者的抗精神病药剂量较高。这使得 GMU（分别为 4.1%和 10.7%）和对照组（分别为 1.3%和 7.7%）患者的压疮和医院感染率低于 GMU 前患者（分别为 9.1%和 23.4%）（P<0.05）。三组患者的死亡率或出院去向无差异。GMU 患者的护理人员认为多组分干预措施有用，有计划的活动被认为对患者从谵妄发作中恢复最有益。
本研究表明，对于老年人来说，专门的谵妄管理单元具有益处。因此，GMU 模式是一个相关的护理系统，适用于老龄化速度快、虚弱老年人住院率高的国家，可以很容易地在急性护理环境中实施。
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