Department of Medicine, McMaster University, IHB/HSC-McMaster 3016, Victoria 10B St. S., Kitchener, ON, N2G 1C5, Canada.
Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
BMC Geriatr. 2018 Feb 2;18(1):39. doi: 10.1186/s12877-018-0733-3.
Nursing home residents are frail, have multiple medical comorbidities, and are at high risk for delirium. Most of the existing evidence base on delirium is derived from studies in the acute in-patient population. We examine the association between clinical characteristics and medication use with the incidence of delirium during the nursing home stay.
This is a retrospective cohort study of 1571 residents from 12 nursing homes operated by a single care provider in Ontario, Canada. Residents were over the age of 55 and admitted between February 2010 and December 2015 with no baseline delirium and a minimum stay of 180 days. Residents with moderate or worse cognitive impairment at baseline were excluded. The baseline and follow-up characteristics of residents were collected from the Resident Assessment Instrument-Minimal Data Set 2.0 completed at admission and repeated quarterly until death or discharge. Multivariate logistic regression was used to identify characteristics and medication use associated with the onset of delirium.
The incidence of delirium was 40.4% over the nursing home stay (mean LOS: 32 months). A diagnosis of dementia (OR: 2.54, p < .001), the presence of pain (OR: 1.64, p < .001), and the use of antipsychotics (OR: 1.87, p < .001) were significantly associated with the onset of delirium. Compared to residents who did not develop delirium, residents who developed a delirium had a greater increase in the use of antipsychotics and antidepressants over the nursing home stay.
Dementia, the presence of pain, and the use of antipsychotics were associated with the onset of delirium. Pain monitoring and treatment may be important to decrease delirium in nursing homes. Future studies are necessary to examine the prescribing patterns in nursing homes and their association with delirium.
养老院居民身体虚弱，患有多种合并症，并且发生谵妄的风险很高。大多数关于谵妄的现有证据基础来自于急性住院患者人群的研究。我们研究了临床特征和药物使用与养老院居住期间谵妄发生率之间的关系。
这是一项对加拿大安大略省一家单一护理提供者运营的 12 家养老院的 1571 名居民进行的回顾性队列研究。居民年龄在 55 岁以上，在 2010 年 2 月至 2015 年 12 月期间入院，入院时无谵妄且入住时间至少为 180 天。入院时存在中度或更严重认知障碍的居民被排除在外。居民的基线和随访特征是从入院时完成的居民评估工具-最小数据集中收集的，每季度重复一次，直到死亡或出院。采用多变量逻辑回归确定与谵妄发生相关的特征和药物使用情况。
养老院入住期间谵妄的发生率为 40.4%（平均 LOS：32 个月）。痴呆诊断（OR：2.54，p<.001）、疼痛存在（OR：1.64，p<.001）和抗精神病药物使用（OR：1.87，p<.001）与谵妄的发生显著相关。与未发生谵妄的居民相比，发生谵妄的居民在养老院入住期间抗精神病药物和抗抑郁药物的使用量显著增加。
痴呆、疼痛的存在和抗精神病药物的使用与谵妄的发生相关。疼痛监测和治疗可能对减少养老院的谵妄很重要。需要进一步研究来检查养老院的处方模式及其与谵妄的关系。
