Balzer Anna, Novak Anne Marie, Marom Pnina, Schwartz Oren, Brik Michael, Slutzki Katia, Heruti Rafi J, Dankner Rachel
Reuth Tel Aviv Rehabilitation Hospital, Tel Aviv 6772830, Israel.
Department of Physical Medicine and Rehabilitation, School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2024 Dec 4;13(23):7394. doi: 10.3390/jcm13237394.
: Delirium is a common neuropsychiatric syndrome characterized by the acute and fluctuating impairment of cognition, attention, and consciousness, which is prevalent in older adults following surgical procedures. Despite the recognized impact of delirium on recovery, its specific effects on motor rehabilitation outcomes in the geriatric population remain underexplored. This historical cohort study aimed to evaluate the association between the presence of delirium upon admission to a rehabilitation hospital and the motor functional gain at discharge among older patients following hip fracture surgery. : The collected data included socio-demographic characteristics, comorbidities, medications, Mini-Mental State Examination (MMSE) scores, and the Functional Independence Measure (FIM). Motor rehabilitation outcomes were assessed using Motor Absolute Functional Gain (mAFG), the Montebello Rehabilitation Factor Score (mMRFS), and Rehabilitation Efficiency (mRE). : Of the 143 hip fracture patients admitted for rehabilitation, 38 (26.6%) were diagnosed with delirium. Patients with delirium had lower MMSE scores (18.1 ± 5.8 vs. 22.4 ± 6.0, < 0.001), higher benzodiazepine prescription rates (50.0% vs. 14.3%, < 0.001), and longer lengths of stay in acute care and rehabilitation (42.7 ± 10.4 vs. 37.3 ± 11.2 days, = 0.01). Despite significant improvements in the FIM scores for both groups ( < 0.001), patients with delirium had lower mAFG (11.87 ± 7.26 vs. 15.91 ± 8.73, = 0.01), mMRFS (0.22 ± 0.14 vs. 0.31 ± 0.15, = 0.001), and mRE (0.28 ± 0.17 vs. 0.44 ± 0.25, < 0.001). However, the multivariate regression models showed no association between delirium and functional improvement after adjusting for confounders. : While both patients with and without delirium showed improvement in their motor functions by the time they were discharged from a rehabilitation hospital, patients with delirium showed lower absolute and relative improvements. Tailored programs addressing the special needs of patients with delirium after hip fracture surgery may enhance outcomes for this vulnerable population. A specialized, multidisciplinary approach tailored to the patient's cognitive status and overall condition is key to maximizing the recovery of older hip fracture patients with delirium.
谵妄是一种常见的神经精神综合征，其特征为认知、注意力和意识的急性波动性损害，在外科手术后的老年人中很常见。尽管谵妄对康复的影响已得到公认，但其对老年人群运动康复结局的具体影响仍未得到充分研究。这项历史性队列研究旨在评估康复医院入院时谵妄的存在与髋部骨折手术后老年患者出院时运动功能改善之间的关联。
收集的数据包括社会人口统计学特征、合并症、用药情况、简易精神状态检查表（MMSE）评分以及功能独立性测量表（FIM）。使用运动绝对功能增益（mAFG）、蒙特贝洛康复因子评分（mMRFS）和康复效率（mRE）来评估运动康复结局。
在143名因康复入院的髋部骨折患者中，38名（26.6%）被诊断为谵妄。谵妄患者的MMSE评分较低（18.1±5.8对22.4±6.0，P<0.001），苯二氮䓬类药物处方率较高（50.0%对14.3%，P<0.001），急性护理和康复住院时间更长（42.7±10.4天对37.3±11.2天，P=0.01）。尽管两组的FIM评分均有显著改善（P<0.001），但谵妄患者的mAFG较低（11.87±7.26对15.91±8.73，P=0.01），mMRFS较低（0.22±0.14对0.31±0.15，P=0.001），mRE较低（0.28±0.17对0.44±0.25，P<0.001）。然而，多变量回归模型显示，在调整混杂因素后，谵妄与功能改善之间无关联。
虽然谵妄患者和非谵妄患者在从康复医院出院时运动功能均有改善，但谵妄患者的绝对和相对改善程度较低。针对髋部骨折手术后谵妄患者特殊需求的定制方案可能会改善这一脆弱人群的结局。根据患者的认知状态和整体状况量身定制的专业多学科方法是使伴有谵妄的老年髋部骨折患者恢复最大化的关键。
