抑郁障碍和痴呆与髋部骨折老年人死亡率的关系。
Association of depressive disorders and dementia with mortality among older people with hip fracture.
机构信息
Department of Nursing, Umeå University, Umeå, Sweden.
Department of Community Medicine and Rehabilitation, Geriatric Medicine Division, Umeå University, Umeå, Sweden.
出版信息
BMC Geriatr. 2023 Mar 9;23(1):135. doi: 10.1186/s12877-023-03862-w.
BACKGROUND
Hip fracture (HF) is a significant cause of mortality among older people. Almost half of the patients with HF have dementia, which increases the mortality risk further. Cognitive impairment is associated with depressive disorders (DDs) and both dementia and DDs are independent risk factors for poor outcome after HF. However, most studies that evaluate mortality risk after HF separate these conditions.
AIMS
To investigate whether dementia with depressive disorders (DDwD) affects the mortality risk at 12, 24, and 36 months after HF among older people.
METHODS
Patients with acute HF (n = 404) were included in this retrospective analysis of two randomized controlled trials performed in orthopedic and geriatric departments. Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive function was assessed using the Mini-Mental State Examination. A consultant geriatrician made final depressive disorder and dementia diagnoses using the Diagnostic and Statistical Manual of Mental Disorders criteria, with support from assessments and medical records. The 12-, 24- and 36-month mortality after HF was analyzed using logistic regression models adjusted for covariates.
RESULTS
In analyses adjusted for age, sex, comorbidity, pre-fracture walking ability, and fracture type, patients with DDwD had increased mortality risks at 12 [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.75-12.51], 24 (OR 3.61, 95% CI 1.71-7.60), and 36 (OR 4.53, 95% CI 2.24-9.14) months. Similar results were obtained for patients with dementia, but not depressive disorders, alone.
CONCLUSION
DDwD is an important risk factor for increased mortality at 12, 24, and 36 months after HF among older people. Routinely assessments after HF for cognitive- and depressive disorders could identify patients at risk for increased mortality, and enable early interventions.
TRIAL REGISTRATION
RCT2: International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN15738119.
背景
髋部骨折（HF）是老年人死亡的重要原因。近一半的 HF 患者患有痴呆症，这进一步增加了死亡率风险。认知障碍与抑郁障碍（DD）有关，痴呆症和 DD 都是 HF 后不良预后的独立危险因素。然而，大多数评估 HF 后死亡率风险的研究都将这些情况分开。
目的
探讨痴呆合并抑郁障碍（DDwD）是否会影响老年人 HF 后 12、24 和 36 个月的死亡率。
方法
本回顾性分析纳入了两项在骨科和老年科进行的随机对照试验中的 404 例急性 HF 患者。使用老年抑郁量表评估抑郁症状，使用简易精神状态检查评估认知功能。顾问老年病学家使用精神障碍诊断和统计手册标准，在评估和病历的支持下，做出最终的抑郁障碍和痴呆症诊断。使用逻辑回归模型调整协变量后，分析 HF 后 12、24 和 36 个月的死亡率。
结果
在调整年龄、性别、合并症、骨折前行走能力和骨折类型后，DDwD 患者的 12 个月[优势比（OR）4.67，95%置信区间（CI）1.75-12.51]、24 个月（OR 3.61，95% CI 1.71-7.60）和 36 个月（OR 4.53，95% CI 2.24-9.14）的死亡风险增加。单独患有痴呆症但无抑郁障碍的患者也得到了类似的结果。
结论
DDwD 是老年人 HF 后 12、24 和 36 个月死亡率增加的重要危险因素。HF 后常规评估认知和抑郁障碍可以识别死亡风险增加的患者，并进行早期干预。
试验注册
RCT2：国际标准随机对照试验编号注册，试验注册编号：ISRCTN82052244。
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