Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
Division of Geriatric Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland.
Dement Geriatr Cogn Disord. 2021;50(3):296-302. doi: 10.1159/000518487. Epub 2021 Sep 8.
Older hip fracture patients are at high risk of delirium during acute hospital care. Pre-fracture dementia is known to increase the risk of in-hospital delirium. Data on the development of new cognitive disorders in patients with delirium are scarce.
The objective of this study is to evaluate the prognostic significance of in-hospital delirium on the development of new cognitive disorders in a 1-year follow-up in older hip fracture patients.
Data consisted of 476 hip fracture patients aged 65 years or more with no known cognitive disorder on admission. Delirium was assessed using the Confusion Assessment Method (CAM). Cognitive disorders were diagnosed following the national guidelines. Information on the new diagnoses of cognitive disorders (NDCD) at 1-year follow-up was elicited in a telephone interview and confirmed from the electronic patient files. Logistic regression analyses were conducted to examine the association of delirium with NDCDs.
Of the 476 patients, 87 (18%) had delirium during hospital stay. Patients with delirium were older, they had poorer nutritional status, lower mobility level, and more supported living arrangements than did patients without delirium. At the 1-year time point, 205 (43%) had NDCDs or were strongly suspected of this. CAM result was statistically significantly associated with development of NDCD in multivariable-adjusted analysis (odds ratio [OR] 2.29; 95% confidence interval [CI]: 1.39-3.79). Also, poor nutritional status continued to be associated with NDCDs (multivariable-adjusted OR 1.58; 95% CI: 1.03-2.43).
Delirium during hospitalization and poor nutritional status on admission are independent prognostic factors for development of subsequent cognitive disorders in older hip fracture patients.
老年髋部骨折患者在急性医院护理期间发生谵妄的风险很高。已知骨折前痴呆症会增加住院期间发生谵妄的风险。关于谵妄患者新发认知障碍发展的数据很少。
本研究旨在评估住院期间谵妄对老年髋部骨折患者 1 年随访中新发认知障碍发展的预后意义。
数据包括 476 名年龄在 65 岁及以上、入院时无已知认知障碍的髋部骨折患者。使用意识模糊评估法（CAM）评估谵妄。根据国家指南诊断认知障碍。通过电话访谈获得 1 年随访中新诊断的认知障碍（NDCD）的信息，并从电子患者档案中确认。进行逻辑回归分析以检查谵妄与 NDCD 之间的关联。
在 476 名患者中，87 名（18%）在住院期间发生谵妄。谵妄患者年龄较大，营养状况较差，活动能力较低，支持性生活安排较多。在 1 年时间点，205 名（43%）患有 NDCD 或强烈怀疑患有 NDCD。CAM 结果在多变量调整分析中与 NDCD 的发展具有统计学显著相关性（优势比[OR]2.29；95%置信区间[CI]1.39-3.79）。此外，入院时的营养状况差也与 NDCD 相关（多变量调整后的 OR 1.58；95% CI 1.03-2.43）。
住院期间谵妄和入院时营养状况差是老年髋部骨折患者继发认知障碍发展的独立预后因素。
