养老院居民新发癫痫和癫痫发作。
New Onset (Incidence) of Epilepsy and Seizures in Nursing Home Residents.
机构信息
Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Am Med Dir Assoc. 2022 Sep;23(9):1589.e11-1589.e15. doi: 10.1016/j.jamda.2022.06.001. Epub 2022 Jun 30.
OBJECTIVE
The point prevalence of epilepsy is high in nursing homes (NH), but the incidence of epilepsy after admission is unknown. This study was done to determine the incidence of epilepsy/seizure (epi/sz) comorbid with other conditions in older adult NH residents.
DESIGN
Retrospective evaluation of Minimum Data Set records to identify new onset epi/sz in NH residents.
SETTING AND PARTICIPANTS
Five cross-sectional cohorts of all residents in any Medicare/Medicaid certified NH in the United States on July 15 of each year 2003-2007.
MEASURES
Epi/sz was identified by International Classification of Diseases, Ninth Revision codes (345.xx or 780.39) or check box on the Minimum Data Set. Those with no such code on admission and with 1 to 3 plus years of follow-up (n = 3,609,422) were followed through 2007 or end of stay.
RESULTS
Overall incidence of epi/sz was 16.42/1000 patient years (PY). Incidence was highest in the first year after admission and declined thereafter. There were more women (n = 2,523,951) than men (n = 1,089,631), but men had a higher incidence (21.17/1000PY) compared with women (14.81/1000PY). Although the 65‒74 years of age cohort included fewer residents (n = 594,722) compared with the age 85 years + cohort (n = 1,520,167), the younger residents had the highest incidence (28.53/1000 PY) compared with the oldest, 10.22/1000 PY for the age 85+ years cohort. The highest incidences were among those with brain tumor (122.55/1000PY), followed by head injury (45.66/1000PY). Overall, 714,340 had a diagnosis of stroke, and incidence was 27.52/1000PY. Those with none of selected risk factors had an overall incidence of 12.45/1000PY.
CONCLUSIONS AND IMPLICATIONS
The incidence of epi/sz in older individuals after admission to a NH is high. There is a need to develop practice approaches to best manage this large cohort. There does not appear to be a uniform approach to managing new onset epilepsy in NHs at this time. Studies to develop evidence for practice guidelines are needed.
目的
养老院（NH）中癫痫的点患病率较高，但入院后癫痫的发病率尚不清楚。本研究旨在确定老年 NH 居民中癫痫/发作（epi/sz）合并其他疾病的发病率。
设计
对最小数据集记录进行回顾性评估，以确定 NH 居民中新发的 epi/sz。
地点和参与者
2003 年至 2007 年，每年 7 月 15 日，美国任何 Medicare/Medicaid 认证的 NH 中所有居民的 5 个横断面队列。
措施
通过国际疾病分类，第九版代码（345.xx 或 780.39）或最小数据集上的复选框识别 epi/sz。那些在入院时没有此类代码且随访 1 至 3 年以上（n=3609422）的患者，随访至 2007 年或入住结束。
结果
总体 epi/sz 发病率为 16.42/1000 患者年（PY）。发病率在入院后第一年最高，此后下降。女性（n=2523951）多于男性（n=1089631），但男性的发病率（21.17/1000PY）高于女性（14.81/1000PY）。尽管 65-74 岁年龄组的居民（n=594722）少于 85 岁以上年龄组（n=1520167），但年轻居民的发病率最高（28.53/1000 PY），而最年长居民的发病率最低，为 10.22/1000 PY 岁以上年龄组。发病率最高的是脑肿瘤（122.55/1000PY），其次是头部受伤（45.66/1000PY）。总体而言，有 714340 人患有中风诊断，发病率为 27.52/1000PY。那些没有选择的危险因素的人总的发病率为 12.45/1000PY。
结论和意义
NH 中老年人入院后癫痫的发病率较高。需要制定最佳管理此类庞大患者群体的实践方法。目前似乎没有针对 NH 中新发癫痫的统一管理方法。需要开展研究以制定实践指南的证据。
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