Centre de recherche du CHU de Québec-Université Laval, Québec, Canada.
Université Laval, Québec, Canada.
Age Ageing. 2021 Jan 8;50(1):135-140. doi: 10.1093/ageing/afaa128.
the aim of this study was to evaluate the impact of emergency department (ED) stay-associated delirium on older patient's functional and cognitive status at 60 days post ED visit.
this study was part of the multi-centre prospective cohort INDEED study. This project took place between March 2015 and July 2016 in five participating EDs across the province of Quebec. Independent non-delirious patients aged ≥65, with an ED stay ≥8 hours, were monitored for delirium until 24 hours post ward admission. A 60-day follow-up phone assessment was conducted. Participants were screened for delirium using the Confusion Assessment Method. Functional and cognitive statuses were assessed at baseline and at the 60-day follow-up using OARS and TICS-m.
a total of 608 patients were recruited, 393 of which completed the 60-day follow-up. The Confusion Assessment Method was positive in 69 patients (11.8%) during ED stay or within the first 24 hours following ward admission. At 60 days, delirium patients experienced an adjusted loss of -2.9/28 [95%CI: -3.9, -2.0] points on the OARS scale compared to non-delirious patients who lost -1.6 [95%CI: -1.9, -1.3] (P = 0.006). A significant adjusted difference in cognitive function was also noted at 60 days, as TICS-m scores in delirious patients decreased by -1.6 [95%CI: -3.5, 0.2] compared to non-delirious patients, who showed a minor improvement of 0.5 [95%CI: -0.1, 1.1] (P = 0.03).
seniors who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients, and they will experience a more significant decline at 60 days post ED visit.
本研究旨在评估急诊（ED）留观相关谵妄对 ED 就诊 60 天后老年患者功能和认知状态的影响。
本研究是多中心前瞻性队列研究 INDEED 的一部分。该项目于 2015 年 3 月至 2016 年 7 月在魁北克省的五个参与 ED 进行。监测≥65 岁、ED 留观时间≥8 小时且无谵妄的独立非谵妄患者，直至病房入院后 24 小时，进行 60 天随访电话评估。使用意识模糊评估方法对患者进行谵妄筛查。使用 OARS 和 TICS-m 在基线和 60 天随访时评估功能和认知状态。
共纳入 608 例患者，其中 393 例完成 60 天随访。ED 留观期间或病房入院后 24 小时内，69 例（11.8%）患者的意识模糊评估方法呈阳性。与非谵妄患者（OARS 量表评分下降 1.6 分[95%CI：1.9，1.3]）相比，谵妄患者在 60 天时调整后的 OARS 量表评分损失为-2.9/28 分[95%CI：-3.9，-2.0]（P=0.006）。60 天时，认知功能也存在显著的调整后差异，谵妄患者 TICS-m 评分下降-1.6 分[95%CI：-3.5，0.2]，而非谵妄患者评分略有改善 0.5 分[95%CI：-0.1，1.1]（P=0.03）。
发生 ED 留观相关谵妄的老年人的基线功能和认知状态低于非谵妄患者，在 ED 就诊后 60 天，他们的功能和认知状态会显著下降。
