Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore.
Geriatr Gerontol Int. 2017 Dec;17(12):2472-2478. doi: 10.1111/ggi.13108. Epub 2017 Jun 22.
To investigate the association between frailty and incomplete delirium recovery at discharge (residual subsyndromal delirium [RSSD]), and to examine the mediating role of RSSD in the relationship between frailty and functional recovery at 12 months post-delirium.
This was a prospective observational study of 234 individuals aged ≥65 years admitted to a specialized delirium unit. A 20-item frailty index was derived using items from a comprehensive geriatric assessment. Individuals with frailty index ≥0.25 were defined as being frail. Diagnosis of delirium was in accordance with the Confusion Assessment Method. RSSD was defined by the Delirium Rating Scale-Revised-98 severity score of ≥13. We measured functional status (modified Barthel Index) on admission and 12 months post-delirium. We carried out mediation analysis to elucidate the role of baseline frailty and RSSD on 12-month functional recovery.
A total of 167 (71%) older adults were available for analysis of 12-month functional status. Frailty was an independent predictor for RSSD (OR 4.1, 95% CI 2.1-8.2, P < 0.001) and functional recovery at 12 months post-delirium (β = -13.4, 95% CI -24.9 to -1.8, P = 0.02). RSSD significantly mediated the effect of baseline frailty status on functional recovery at 12 months (coefficient = -0.1, 95% CI -0.2 to -0.02, P = 0.02), with 45% of the total effect mediated by RSSD.
Frailty as a risk factor for poor functional recovery in the year post-delirium might be attributable in part to its impact on incomplete delirium recovery at discharge (RSSD). Our findings support screening and interventions for frailty at admission, and extended rehabilitation for frail individuals with RSSD. Geriatr Gerontol Int 2017; 17: 2472-2478.
探讨衰弱与出院时不完全谵妄恢复（残留亚综合征谵妄[RSSD]）之间的关系，并检验 RSSD 在衰弱与谵妄后 12 个月功能恢复之间的关系中的中介作用。
这是一项对 234 名年龄≥65 岁入住专门的谵妄病房的患者进行的前瞻性观察性研究。使用综合老年评估中的 20 项衰弱指数来确定衰弱指数。衰弱指数≥0.25 的个体被定义为衰弱。谵妄的诊断符合意识混乱评估方法。RSSD 定义为修订后的谵妄评定量表-98 严重程度评分≥13。我们在入院时和谵妄后 12 个月测量功能状态（改良巴氏量表）。我们进行了中介分析，以阐明基线时的衰弱和 RSSD 对 12 个月时功能恢复的作用。
共有 167 名（71%）老年人可用于分析 12 个月的功能状态。衰弱是 RSSD（比值比 4.1，95%置信区间 2.1-8.2，P<0.001）和谵妄后 12 个月功能恢复的独立预测因素（β=-13.4，95%置信区间-24.9 至-1.8，P=0.02）。RSSD 显著中介了基线衰弱状况对 12 个月功能恢复的影响（系数=-0.1，95%置信区间-0.2 至-0.02，P=0.02），其中 45%的总效应由 RSSD 介导。
衰弱作为谵妄后 1 年功能恢复不良的危险因素，部分归因于其对出院时不完全谵妄恢复（RSSD）的影响。我们的研究结果支持在入院时进行衰弱筛查和干预，并为 RSSD 衰弱患者提供扩展康复治疗。老年医学与老年病学国际 2017；17：2472-2478。
