Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Asian J Psychiatr. 2024 Apr;94:103990. doi: 10.1016/j.ajp.2024.103990. Epub 2024 Mar 1.
Delirium is a common complication in hospitalized older adults with multifactorial etiology and poor health outcomes.
To determine the frequency and predictors of delirium and its short-term and long-term outcomes in hospitalized older adults.
A prospective observational study was performed in patients aged ≥60 years consecutively admitted to geriatric ward. Potential risk factors were assessed within 24 hours of hospital admission. Delirium screening was performed on admission and daily thereafter throughout the hospital stay using Confusion Assessment Method (CAM). Patients were followed up at 1-year post-discharge.
The study included 200 patients with mean age 73.1 ± 8.83 years. Incidence and prevalence rate of delirium were 5% and 20% respectively. Multivariable regression analysis revealed emergency admission (OR= 5.12 (1.94-13.57), p=0.001), functional dependency (Katz index of Independence in Activities of Daily Living (Katz-ADL) score <5) 2 weeks before admission (OR= 3.08 (1.30-7.33), p=0.011) and more psychopathological symptoms (higher Brief Psychiatric Rating Scale (BPRS) total score) (OR=1.12 (1.06-1.18), p=0.001) to be independently associated with delirium. Patients in delirium group had significantly high in-hospital mortality (OR= 5.02 (2.12-11.8), p=0.001) and post-discharge mortality (HR= 2.02 (1.13-3.61), p=0.017) and functional dependency (Katz-ADL score <5) (OR= 5.45 (1.49-19.31), p=0.01) at 1-year follow up.
Delirium is quite frequent in geriatric inpatients and is associated with high in-hospital and post-discharge mortality risk and long-term functional dependency. Emergency admission, pre-hospitalization functional dependency, and more general psychopathological symptoms are independently associated factors. Hence, earliest identification and treatment with early implementation of rehabilitation services is warranted.
谵妄是住院老年患者常见的并发症，其病因复杂，健康结局较差。
确定住院老年患者谵妄的发生频率及其短期和长期结局，并确定其预测因素。
对连续入住老年病房的 60 岁以上患者进行前瞻性观察性研究。在入院后 24 小时内评估潜在的危险因素。入院时及住院期间每天使用意识模糊评估法（CAM）进行谵妄筛查。患者在出院后 1 年进行随访。
本研究纳入 200 例患者，平均年龄为 73.1±8.83 岁。谵妄的发生率和患病率分别为 5%和 20%。多变量回归分析显示，急诊入院（OR=5.12（1.94-13.57），p=0.001）、入院前 2 周功能依赖（Katz 日常生活活动指数（Katz-ADL）评分<5）（OR=3.08（1.30-7.33），p=0.011）和更多的精神病理症状（更高的简明精神病评定量表（BPRS）总分）（OR=1.12（1.06-1.18），p=0.001）与谵妄独立相关。谵妄组患者住院期间死亡率（OR=5.02（2.12-11.8），p=0.001）和出院后死亡率（HR=2.02（1.13-3.61），p=0.017）以及 1 年随访时的功能依赖（Katz-ADL 评分<5）（OR=5.45（1.49-19.31），p=0.01）显著较高。
老年住院患者谵妄较为常见，与住院期间和出院后死亡风险增加以及长期功能依赖相关。急诊入院、入院前功能依赖和更多的一般精神病理症状是独立的相关因素。因此，需要尽早识别和治疗，并尽早实施康复服务。
