Cole Martin G, Bailey Robert, Bonnycastle Michael, McCusker Jane, Fung Shek, Ciampi Antonio, Belzile Eric, Bai Chun
Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
St. Mary's Research Centre, Montreal, Quebec, Canada.
J Am Geriatr Soc. 2015 Nov;63(11):2340-8. doi: 10.1111/jgs.13791. Epub 2015 Oct 30.
To determine the frequency and baseline risk factors for partial and no recovery from delirium in older hospitalized adults.
Cohort study with assessment of recovery status approximately 1 and 3 months after enrollment.
University-affiliated, primary, acute-care hospital.
Medical or surgical inpatients aged 65 and older with delirium (N = 278).
The Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), and activities of daily living (ADLs) were completed at enrollment and each follow-up. Primary outcome categories were full recovery (absence of CAM core symptoms of delirium), partial recovery (presence of ≥1 CAM core symptoms but not meeting criteria for delirium), no recovery (met CAM criteria for delirium), or death. Secondary outcomes were changes in MMSE, DI, and ADL scores between the baseline and last assessment. Potential risk factors included many clinical and laboratory variables.
In participants with dementia, frequencies of full, partial, and no recovery and death at first follow-up were 6.3%, 11.3%, 74.6%, and 7.7%, respectively; in participants without dementia, frequencies were 14.3%, 17%, 50.9%, and 17.9%, respectively. In participants with dementia, frequencies at the second follow-up were 7.9%, 15.1%, 57.6%, and 19.4%, respectively; in participants without dementia, frequencies were 19.2%, 20.2%, 31.7%, and 28.8%, respectively. Frequencies were similar in participants with prevalent and incident delirium and in medical and surgical participants. The DI, MMSE, and ADL scores of many participants with partial and no recovery improved. Independent baseline risk factors for delirium persistence were chart diagnosis of dementia (odds ratio (OR) = 2.51, 95% confidence interval (CI) =1.38, 4.56), presence of any malignancy (OR = 5.79, 95% CI = 1.51, 22.19), and greater severity of delirium (OR =9.39, 95% CI = 3.95, 22.35).
Delirium in many older hospitalized adults appears to be much more protracted than previously thought, especially in those with dementia, although delirium symptoms, cognition, and function improved in many participants with partial and no recovery. It may be important to monitor the longer-term course of delirium in older hospitalized adults and develop strategies to ensure full recovery.
确定老年住院患者谵妄部分恢复或未恢复的频率及基线风险因素。
队列研究，在入组后约1个月和3个月评估恢复状态。
大学附属医院的初级急症护理医院。
65岁及以上患有谵妄的内科或外科住院患者（N = 278）。
在入组时及每次随访时完成简易精神状态检查表（MMSE）、谵妄评定方法（CAM）、谵妄指数（DI）及日常生活活动能力（ADL）评估。主要结局类别为完全恢复（无谵妄的CAM核心症状）、部分恢复（存在≥1项CAM核心症状但未达到谵妄标准）、未恢复（符合谵妄的CAM标准）或死亡。次要结局为基线与末次评估之间MMSE、DI及ADL评分的变化。潜在风险因素包括许多临床和实验室变量。
在患有痴呆症的参与者中，首次随访时完全恢复、部分恢复、未恢复及死亡的频率分别为6.3%、11.3%、74.6%和7.7%；在无痴呆症的参与者中，频率分别为14.3%、17%、50.9%和17.9%。在患有痴呆症的参与者中，第二次随访时的频率分别为7.9%、15.1%、57.6%和19.4%；在无痴呆症的参与者中，频率分别为19.2%、20.2%、31.7%和28.8%。在患有既往谵妄和新发谵妄的参与者以及内科和外科参与者中，频率相似。许多部分恢复和未恢复的参与者的DI、MMSE及ADL评分有所改善。谵妄持续存在的独立基线风险因素为痴呆症的病历诊断（比值比（OR）= 2.51，95%置信区间（CI）= 1.38，4.56）、存在任何恶性肿瘤（OR = 5.79，95% CI = 1.51，22.19）以及谵妄的严重程度更高（OR = 9.39，95% CI = 3.95，22.35）。
许多老年住院患者的谵妄似乎比之前认为的持续时间长得多，尤其是在患有痴呆症的患者中，尽管许多部分恢复和未恢复的参与者的谵妄症状、认知及功能有所改善。监测老年住院患者谵妄的长期病程并制定确保完全恢复的策略可能很重要。
