Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Room Rg-527, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Hospital Pharmacy, Franciscus Gasthuis and Vlietland, Rotterdam and Schiedam, The Netherlands.
Drugs Aging. 2021 Jan;38(1):53-62. doi: 10.1007/s40266-020-00813-7. Epub 2020 Nov 9.
Delirium affects approximately one out of three older hospitalized patients and is associated with poor clinical outcomes. Approaches used to manage delirium consist of non-pharmacological and pharmacological interventions. Antipsychotics and lorazepam are commonly used to treat symptoms of delirium, but conflicting data exist on the effect of these drugs on the outcomes of delirium.
The aim of this study was to investigate whether the use of antipsychotics, with or without lorazepam, increases the risk of prolonged hospital stay, post-discharge institutionalization, and in-hospital mortality in older patients with delirium.
In this retrospective chart review study, we included acutely ill patients aged ≥ 65 years who were admitted to a geriatric ward and diagnosed with delirium. Patients were stratified into three groups based on whether or not they received antipsychotics and lorazepam to manage delirium: (0) no antipsychotics; (1) antipsychotics only; and (2) antipsychotics plus lorazepam. Length of hospital stay (LOS) and frequencies of post-discharge institutionalization and in-hospital mortality were compared.
In total, 212 patients with delirium were included (mean age 81.9 ± 5.6 years); 40 did not receive antipsychotics (18.9%), 123 received antipsychotics only (58.0%) and 49 received antipsychotics and lorazepam (23.1%). There was a trend to a longer LOS in patients who received both antipsychotics and lorazepam (median LOS group 0 = 8.0 days, group 1 = 10.0 days, and group 2 = 12.0 days). Furthermore, trends to a higher incidence of post-discharge institutionalization and in-hospital mortality were observed in patients who received both treatments (institutionalization group 0 = 45.0%, group 1 = 59.3%, group 2 = 81.6%; and in-hospital mortality group 0 = 7.5%, group 1 = 10.6%, group 2 = 16.3%).
The use of antipsychotics, with or without lorazepam, during delirium is associated with increased risks of poor outcomes. These findings suggest that clinicians should be cautious about routine prescribing of these drugs to older patients with delirium. Further investigation is needed to clarify this association.
谵妄影响约三分之一的老年住院患者，与不良临床结局相关。用于治疗谵妄的方法包括非药物和药物干预。抗精神病药和劳拉西泮常用于治疗谵妄症状，但这些药物对谵妄结局的影响存在相互矛盾的数据。
本研究旨在探讨在患有谵妄的老年患者中，使用抗精神病药（联合或不联合劳拉西泮）是否会增加住院时间延长、出院后机构化和院内死亡率的风险。
在这项回顾性病历审查研究中，我们纳入了年龄≥65 岁的急性病住院患者，这些患者被诊断为谵妄。根据是否使用抗精神病药和劳拉西泮来治疗谵妄，将患者分为三组：（0）未使用抗精神病药；（1）仅使用抗精神病药；和（2）使用抗精神病药加劳拉西泮。比较住院时间（LOS）、出院后机构化和院内死亡率的频率。
共纳入 212 例谵妄患者（平均年龄 81.9±5.6 岁）；40 例未使用抗精神病药（18.9%），123 例仅使用抗精神病药（58.0%），49 例使用抗精神病药和劳拉西泮（23.1%）。接受抗精神病药和劳拉西泮联合治疗的患者 LOS 有延长的趋势（中位数 LOS 组 0=8.0 天，组 1=10.0 天，组 2=12.0 天）。此外，接受两种治疗的患者出院后机构化和院内死亡率的趋势更高（机构化组 0=45.0%，组 1=59.3%，组 2=81.6%；院内死亡率组 0=7.5%，组 1=10.6%，组 2=16.3%）。
在谵妄期间使用抗精神病药（联合或不联合劳拉西泮）与不良结局风险增加相关。这些发现表明，临床医生应谨慎常规为患有谵妄的老年患者开具这些药物。需要进一步研究以澄清这种关联。
