Levinoff E, Try A, Chabot J, Lee L, Zukor D, Beauchet O
Dr. Elise Levinoff, MD, MSc; Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, 3755 chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada; E-mail:
J Frailty Aging. 2018;7(1):34-39. doi: 10.14283/jfa.2017.37.
Hip fractures precipitate several acute adverse outcomes in elderly people, thus leading to chronic adverse outcomes.
The objective of our study was to examine the clinical characteristics associated with incident delirium in community dwelling elderly individuals who have a hip fracture.
Retrospective observational cohort study.
Data was collected from an academic tertiary hospital affiliated with McGill University.
114 elderly individuals who were above 65 years of age, who underwent surgery for a fractured hip.
The main outcome variable was incident delirium, which was assessed by chart reviews of notes and observations recorded by nurses and physicians when patients were admitted post operatively to the surgical unit. Covariates included age, sex, length of stay, delay to surgery, number of medical comorbidities, number of medications and hip fracture location, and were extracted from medical records. Baseline mobility and functional status, preoperative cognitive impairment, postoperative complications, regular psychotropic medications, psychotropic medications in hospital, and location of discharge were also assessed through chart review.
The results demonstrated that 17.5% of participants with a diagnosis of delirium had a longer length of hospitalization (p = 0.01), a lower baseline functional status (p = 0.03) and pre-operative cognitive impairment (p = 0.01). Patients receiving new psychotropic medications in hospital were more likely to have delirium (OR = 4.6, p = 0.01) which was independent of pre-operative cognitive impairment.
We have shown that an association exists between psychotropic medication prescription and incident delirium in patients with hip fractures, even when adjusting for cognitive impairment. Hence, the prescription of psychotropic drugs should be judicious in these patients so as minimize the risk of adverse outcomes.
髋部骨折会在老年人中引发多种急性不良后果，进而导致慢性不良后果。
我们研究的目的是调查社区居住的髋部骨折老年个体中与新发谵妄相关的临床特征。
回顾性观察队列研究。
数据收集自麦吉尔大学附属的一家学术性三级医院。
114名65岁以上因髋部骨折接受手术的老年人。
主要结局变量是新发谵妄，通过对患者术后入住外科病房时护士和医生记录的笔记及观察进行病历审查来评估。协变量包括年龄、性别、住院时间、手术延迟时间、内科合并症数量、用药数量和髋部骨折部位，这些均从病历中提取。还通过病历审查评估了基线活动能力和功能状态、术前认知障碍、术后并发症、常规精神药物、住院期间的精神药物以及出院地点。
结果表明，诊断为谵妄的参与者中有17.5%住院时间更长（p = 0.01）、基线功能状态更低（p = 0.03）以及术前存在认知障碍（p = 0.01）。住院期间接受新精神药物治疗的患者更易发生谵妄（OR = 4.6，p = 0.01），这与术前认知障碍无关。
我们已表明，即使在调整认知障碍因素后，髋部骨折患者中精神药物处方与新发谵妄之间仍存在关联。因此，对这些患者应谨慎开具精神药物处方，以尽量降低不良后果的风险。
