Silverstone-Simard Isabelle, Wu Joyce, Nassim Marouane, Friedman Ruby, Segal Marilyn, Monette Johanne, Rej Soham
GeriPARTy Research Group, Dept. of Psychiatry, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC.
Division of Geriatric Medicine, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC.
Can Geriatr J. 2021 Jun 1;24(2):111-117. doi: 10.5770/cgj.24.483. eCollection 2021 Jun.
Agitation associated with dementia impacts delivery of medical care and is a major reason for institutionalization in dementia patients. This study examines the association of medication use and other clinical factors with patients' 'dischargeability' (i.e., amount of time until a patient is considered dischargeable from an inpatient unit).
This study was a retrospective chart review examining 200 patients with dementia and agitation, hospitalized at a Canadian acute care geriatric ward between November 2007 and November 2018. The main outcome measure was time until a patient was deemed dischargeable. Univariate linear regression analyses, followed by multiple linear regression analyses, were used.
Risperidone and quetiapine were the most commonly prescribed medications, but were not associated with time until dischargeable. Olanzapine (40.9 vs. 16.2 days until dischargeable, β = 0.23, = .001), regular benzodiazepine (32.7 vs. 16.5 days until dischargeable, β = 0.15, = .027), and as-needed ('PRN') benzodiazepine use (31.7 vs. 15.9 days until dischargeable, β =0.19, = .006) were independently associated with prolonging time until dischargeable.
Olanzapine, benzodiazepine, and PRN benzodiazepine use were associated with longer time until patients with dementia and agitation were considered ready for discharge. This raises the question as to whether the risks of these medications outweigh the benefits in a hospital setting.
与痴呆相关的激越会影响医疗服务的提供，是痴呆患者入住机构护理的主要原因。本研究探讨药物使用及其他临床因素与患者“可出院性”（即患者被认为可从住院单元出院所需的时间）之间的关联。
本研究为一项回顾性病历审查，研究对象为200例患有痴呆且伴有激越症状的患者，这些患者于2007年11月至2018年11月期间在加拿大一家急性护理老年病房住院。主要结局指标为患者被认为可出院所需的时间。采用单因素线性回归分析，随后进行多因素线性回归分析。
利培酮和喹硫平是最常开具的药物，但与可出院时间无关。奥氮平（可出院时间为40.9天对16.2天，β = 0.23，P = .001）、常规苯二氮䓬类药物（可出院时间为32.7天对16.5天，β = 0.15，P = .027）以及按需（“PRN”）使用苯二氮䓬类药物（可出院时间为31.7天对15.9天，β = 0.19，P = .006）与延长可出院时间独立相关。
使用奥氮平、苯二氮䓬类药物和按需使用苯二氮䓬类药物与痴呆且伴有激越症状的患者被认为可出院的时间延长有关。这就提出了一个问题，即在医院环境中，这些药物的风险是否超过了益处。
