West China School of Nursing, Sichuan University/ Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
BMC Geriatr. 2022 Mar 29;22(1):262. doi: 10.1186/s12877-022-02932-9.
Delirium is a common complication that leads to poor health outcomes in older patients undergoing treatment. Due to severe consequences, early recognition of high-risk patients and risk factors for delirium are crucial in the prompt initiation of prevention measures. However, research in medically hospitalized patients aged ≥80 years remains limited. This study aimed to determine the incidence, predictors and health outcomes of delirium in very old (aged ≥80 years) hospitalized patients in China.
A prospective study was conducted in individuals aged ≥80 years admitted to geriatric departments. Potential risk factors were assessed within 24 h after hospital admission. Screening for delirium was performed on admission and every 48 h thereafter for 14 days and assessed if acute mental status changes were observed. During hospitalization, health outcomes were recorded daily.
Incident delirium occurred in 109 of 637 very old hospitalized patients (17.1%). The independent predictors of delirium in hospitalized patients aged 80 and over were cognitive function impairment [OR 17.42, 95% CI:(7.47-40.64)], depression [OR 9.30, 95% CI: (4.59-18.84)], CCI ≥ 5 [OR 4.21, 95% CI: (1.48-12.01)], sleep deprivation [OR 3.89, 95% CI: (1.71-8.82)], infection [OR 3.33, 95% CI: (1.70-6.54)], polypharmacy (≥5 medications) [OR 2.85, 95% CI: (1.51-5.39)], constipation [OR 2.58, 95% CI: (1.33-5.02)], and emergency admission [OR 2.13, 95% CI: (1.02-4.45)]. Patients with delirium had significantly longer hospital stays(P < 0.001) and higher percentages of physical restraint use(P < 0.001) and falls (P = 0.001) than those without delirium,.
The incidence of delirium was high in hospitalized patients aged ≥80 years admitted to the geriatric department and was associated with prolonged hospital stay and higher rates of physical restraint use and falls. In this population, the most important independent risk factors for incident delirium were cognitive function impairment and depression. Health care professionals should recognize and initiate interventions for delirium early in geriatric patients.
谵妄是老年患者治疗过程中常见的并发症，可导致不良健康结局。由于后果严重，早期识别谵妄高危患者和危险因素对于及时启动预防措施至关重要。然而，对 80 岁以上住院患者的医学研究仍然有限。本研究旨在确定中国高龄（≥80 岁）住院患者谵妄的发生率、预测因素和健康结局。
前瞻性研究纳入了老年科收治的≥80 岁患者。在入院后 24 小时内评估潜在的危险因素。入院时及此后每 48 小时进行一次谵妄筛查，以观察急性精神状态变化。住院期间，每天记录健康结局。
637 例高龄住院患者中，109 例（17.1%）发生谵妄。高龄住院患者发生谵妄的独立预测因素为认知功能障碍[比值比（OR）17.42，95%可信区间（CI）：（7.47-40.64）]、抑郁[OR 9.30，95% CI：（4.59-18.84）]、CCI≥5[OR 4.21，95% CI：（1.48-12.01）]、睡眠剥夺[OR 3.89，95% CI：（1.71-8.82）]、感染[OR 3.33，95% CI：（1.70-6.54）]、多药治疗（≥5 种药物）[OR 2.85，95% CI：（1.51-5.39）]、便秘[OR 2.58，95% CI：（1.33-5.02）]和急诊入院[OR 2.13，95% CI：（1.02-4.45）]。发生谵妄的患者住院时间明显更长（P<0.001），使用身体约束的比例更高（P<0.001），跌倒发生率更高（P=0.001）。
高龄（≥80 岁）老年科住院患者谵妄发生率较高，与住院时间延长、身体约束使用率和跌倒发生率较高有关。在该人群中，发生谵妄的最重要独立危险因素是认知功能障碍和抑郁。医护人员应早期识别并干预老年患者的谵妄。
