Nursing School, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
Department of Physiotherapy, Universitat de València, Valencia, Spain.
J Alzheimers Dis. 2019;70(4):1113-1122. doi: 10.3233/JAD-190391.
Delirium is a common geriatric syndrome, with a prevalence of between 15-70% among older long-term care residents. It is associated with adverse outcomes, and its onset may prove imperceptible to health professionals. Few studies in institutionalized older people have analyzed the predictors of delirium.
The aim of the present study was to identify delirium predisposing and triggering factors, and develop a predictive model.
A cohort trial-nested case-control study covering a period of 12 consecutive months (April 2015 - March 2016) was carried out. Predisposing and triggering episodes of delirium were recorded.
A total of 443 older persons were recruited, with a mean age of 85.73 (6.72) years and female predominance (78.3%; n = 374). The incidence of older people with delirium was 18.7% (n = 83). Dementia was the predisposing factor with the highest predictive capacity (OR = 2.74 [1.49-5.04]). In the presence of dementia, falls (OR = 2.45 [1.49-3.69]), neuroleptics (OR = 2.39 [1.23-4.65]) and anticholinergic drug use (OR = 1.87 [0.95-3.69]) were identified as triggering factors. The area under the curve (AUC) was 0.72 (95% CI: 0.66-0.78).
Our findings suggest that interventions targeted to potentially preventable triggering factors could avoid the onset of delirium in older people with dementia. Knowledge of the predictive factors of delirium facilitates the screening of older people at increased risk, thereby allowing mental health service providers to prevent and identify the onset of a delirium episode. The decrease in delirium predictive factors should lead to a direct reduction in the occurrence of delirium and its consequences.
谵妄是一种常见的老年综合征，在长期护理机构的老年人中，其发病率在 15%至 70%之间。它与不良结局有关，其发病可能对医护人员来说难以察觉。在机构化老年人中，很少有研究分析谵妄的预测因素。
本研究旨在确定谵妄的易患和触发因素，并建立预测模型。
进行了一项为期 12 个月（2015 年 4 月至 2016 年 3 月）的队列试验嵌套病例对照研究。记录了谵妄的易患和触发事件。
共纳入 443 名老年人，平均年龄 85.73（6.72）岁，女性居多（78.3%；n=374）。患有谵妄的老年人的发病率为 18.7%（n=83）。痴呆是预测能力最高的易患因素（OR=2.74[1.49-5.04]）。在痴呆的基础上，跌倒（OR=2.45[1.49-3.69]）、使用神经阻滞剂（OR=2.39[1.23-4.65]）和抗胆碱能药物（OR=1.87[0.95-3.69]）被确定为触发因素。曲线下面积（AUC）为 0.72（95%CI：0.66-0.78）。
我们的研究结果表明，针对潜在可预防触发因素的干预措施可能会避免痴呆老年人发生谵妄。了解谵妄的预测因素有助于筛选出高危老年人，从而使精神卫生服务提供者能够预防和识别谵妄发作。降低谵妄的预测因素应直接减少谵妄的发生及其后果。
