Rao Ahsan, Suliman Amna, Vuik Sabine, Aylin Paul, Darzi Ara
Department of Surgery and Cancer, Faculty of Medicine, Floor 10, QEQM, St Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, United Kingdom.
Department of Surgery and Cancer, Faculty of Medicine, Floor 10, QEQM, St Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, United Kingdom.
Arch Gerontol Geriatr. 2016 Sep-Oct;66:198-204. doi: 10.1016/j.archger.2016.06.008. Epub 2016 Jun 16.
Aim of the study was to compare various outcomes of dementia patients with elderly patients without dementia by conducting a systematic review of previous population-based studies.
The relevant studies were retrieved from search of electronic databases.
The pooled data from included 11 studies consisted of outcomes of 1,044,131 dementia patients compared to 9,639,027 elderly patients without dementia. Meta-analysis showed that the mortality in dementia patients was 15.3% as compared to 8.7% in non-dementia cases (RR 1.70, CI 95%, 1.27-2.28, p 0.0004). However, there was significant heterogeneity between the studies (p<0.00001). Dementia patients had significantly increased overall readmission rate (OR 1.18; 95% CI, 1.08-1.29, p<0.001). They had higher complication rates for urinary tract infections (RR 2.88; 95% CI, 2.45-3.40, p<0.0001), pressure ulcers (RR 184; 95% CI, 1.31-1.46, p<0.0001), pneumonia (RR 1.66; 95% CI, 1.36-2.02, p<0.0001), delirium (RR 3.10; 95% CI, 2.31-4.15, p<0.0001), and, dehydration and electrolyte imbalance (RR 1.87; 95% CI, 1.55-2.25, p<0.0001). Dementia patients had more acute cardiac events (HR 1.16; 95% CI, 1.06-1.28, p 0.002), while fewer revascularization procedures (HR 0.12; 95% CI, 0.08-0.20, p<0.001). Patients with dementia had lesser use of ITU (reduction by 7.5%; 95% CI, 6.9-8.1), ventilation (reduction by 5.4%; 95% CI, 5.0-5.9), and dialysis (reduction by 0.5%; 95% CI, 0.4-0.8).
Compared to older adult population, patients with dementia had poorer outcome. Despite higher mortality rate and readmission rate, they underwent fewer interventions and procedures.
本研究的目的是通过对既往基于人群的研究进行系统评价，比较痴呆患者与无痴呆老年患者的各种结局。
通过检索电子数据库获取相关研究。
纳入的11项研究的汇总数据包括1,044,131例痴呆患者与9,639,027例无痴呆老年患者的结局。荟萃分析显示，痴呆患者的死亡率为15.3%，而非痴呆患者为8.7%（相对危险度1.70，95%可信区间，1.27 - 2.28，p = 0.0004）。然而，各研究之间存在显著异质性（p<0.00001）。痴呆患者的总体再入院率显著升高（比值比1.18；95%可信区间，1.08 - 1.29，p<0.001）。他们发生尿路感染的并发症率更高（相对危险度2.88；95%可信区间，2.45 - 3.40，p<0.0001）、压疮（相对危险度1.84；95%可信区间，1.31 - 1.46，p<0.0001）、肺炎（相对危险度1.66；95%可信区间，1.36 - 2.02，p<0.0001）、谵妄（相对危险度3.10；95%可信区间，2.31 - 4.15，p<0.0001）以及脱水和电解质失衡（相对危险度1.87；95%可信区间，1.55 - 2.25，p<0.0001）。痴呆患者发生急性心脏事件更多（风险比1.16；95%可信区间，1.06 - 1.28，p = 0.002），而血管重建手术较少（风险比0.12；95%可信区间，0.08 - 0.20，p<0.001）。痴呆患者入住重症监护病房的比例较低（降低7.5%；95%可信区间，6.9 - 8.1）、接受通气的比例较低（降低5.4%；95%可信区间，5.0 - 5.9）以及接受透析的比例较低（降低0.5%；95%可信区间，0.4 - 0.8）。
与老年人群相比，痴呆患者的结局较差。尽管死亡率和再入院率较高，但他们接受的干预和手术较少。
