Mitchell Rebecca J, Harvey Lara A, Brodaty Henry, Draper Brian, Close Jacqueline C T
Australian Institute of Health Innovation,Macquarie University,North Ryde,Australia.
Falls and Injury Prevention Group,Neuroscience Research Australia,University of New South Wales,Randwick,Australia.
Int Psychogeriatr. 2015 Nov;27(11):1757-68. doi: 10.1017/S1041610215001258. Epub 2015 Aug 4.
Medicinal substances have been identified as common agents of both unintentional and intentional poisoning among older people, including those with dementia. This study aims to compare the characteristics of poisoning resulting in hospitalization in older people with and without dementia and their clinical outcomes.
A retrospective cohort study involving an examination of poisoning by intent involving individuals aged 50+ years with and without dementia using linked hospitalization and mortality records during 2003-2012. Individuals who had dementia were identified from hospital diagnoses and unintentional and intentional poisoning was identified using external cause classifications. The epidemiological profile (i.e. individual and incident characteristics) of poisoning by intent and dementia status was compared, along with clinical outcomes of hospital length of stay (LOS), 28-day readmission and 30-day mortality.
The hospitalization rate for unintentional and intentional poisoning for individuals with dementia was double and 1.5 times higher than the rates for individuals without dementia (69.5 and 31.6 per 100,000) and (56.4 and 32.5 per 100,000). [corrected]. The home was the most common location of poisoning. Unintentional poisoning was more likely to involve individuals residing in aged care facilities (OR 2.12; 95%CI 1.70-2.63) or health service facilities (OR 4.56; 95%CI 4.06-5.13). [corrected]. There were higher mortality rates and longer length of stay [corrected] for unintentional poisoning for individuals with dementia.
Clinicians need to be aware of the risks of poisoning for individuals with dementia and care is required in appropriate prescription, safe administration, and potential for self-harm with commonly used medications, such as anticholinesterase medications, antihypertensive drugs, and laxatives.
药物已被确认为老年人（包括痴呆症患者）非故意和故意中毒的常见因素。本研究旨在比较患有和未患有痴呆症的老年人因中毒住院的特征及其临床结局。
一项回顾性队列研究，利用2003年至2012年期间的住院和死亡记录，对年龄在50岁及以上、患有和未患有痴呆症的个体按中毒意图进行检查。根据医院诊断确定患有痴呆症的个体，并使用外部病因分类确定非故意和故意中毒。比较按中毒意图和痴呆症状态划分的中毒流行病学概况（即个体和事件特征），以及住院时间（LOS）、28天再入院率和30天死亡率等临床结局。
患有痴呆症的个体非故意和故意中毒的住院率分别是未患有痴呆症个体的两倍和1.5倍（分别为每10万人69.5例和31.6例）以及（每10万人56.4例和32.5例）。[已修正]家庭是最常见的中毒地点。非故意中毒更有可能涉及居住在老年护理机构的个体（比值比2.12；95%置信区间1.70 - 2.63）或医疗服务机构的个体（比值比4.56；95%置信区间4.06 - 5.13）。[已修正]患有痴呆症的个体非故意中毒的死亡率更高，住院时间更长[已修正]。
临床医生需要意识到痴呆症患者中毒的风险，在合理开药、安全用药以及常用药物（如抗胆碱酯酶药物、降压药和泻药）的自我伤害可能性方面需谨慎。
