Academic Unit of Elderly Care and Rehabilitation, Bradford Royal Infirmary, Bradford Institute for Health Research, Bradford, West Yorkshire, UK.
Age Ageing. 2015 Nov;44(6):915-7. doi: 10.1093/ageing/afv120. Epub 2015 Aug 26.
Multicomponent delirium prevention strategies have been shown in intervention studies consistently to reduce the occurrence of delirium. Based on this convincing evidence base, the National Institute for Health and Care Excellence has advocated the widespread adoption of multicomponent delirium prevention interventions into the routine inpatient care of older people. However, despite successful reductions in incident delirium of about a third, anticipated reductions in mortality or admissions to long-term care--both clinically important endpoints statistically correlated with the occurrence of delirium--have not been conclusively observed. We hypothesise that the reasons for this disconnection are partly methodological, due to difficulties in delirium detection and blinding of study personnel to the intervention, but predominantly due to the underlying relationship between delirium and the abnormal health state of frailty; the interaction between these two geriatric syndromes is currently poorly understood.
多组分谵妄预防策略在干预研究中已被证实可降低谵妄的发生率。基于这一令人信服的证据基础，国家卫生与保健卓越研究所（National Institute for Health and Care Excellence）主张将多组分谵妄预防干预措施广泛应用于老年人的常规住院治疗中。然而，尽管在预防谵妄发生方面取得了约三分之一的成功，但在预期降低死亡率或减少入住长期护理机构方面——这两个临床重要的终点都与谵妄的发生在统计学上相关——却没有得到明确的观察结果。我们假设造成这种脱节的部分原因是方法学上的，这是由于在检测谵妄和对研究人员进行干预的盲法方面存在困难，但主要原因是谵妄与衰弱这一异常健康状态之间存在潜在的关系；这两种老年综合征之间的相互作用目前还知之甚少。
