Kraemer K L, Mayo-Smith M F, Calkins D R
Division of General Internal Medicine, Deaconess Hospital, Boston, Mass., USA.
Arch Intern Med. 1997 Oct 27;157(19):2234-41.
Early identification of alcohol-dependent patients at increased risk for severe or complicated alcohol withdrawal would improve triage and treatment. However, the role of age in predicting alcohol withdrawal outcomes has not been well studied.
To assess the impact of age on the severity, course, and complications of alcohol withdrawal.
We performed a retrospective cohort study of 284 inpatients admitted for alcohol withdrawal between September 1992 and August 1994. Outcomes included alcohol withdrawal severity measured by the revised Clinical Institute Withdrawal Assessment for Alcohol scale, quantity and duration of benzodiazepine therapy, and complications during withdrawal.
Initial and maximal withdrawal severity scores, amount of benzodiazepine administered, and duration of benzodiazepine treatment for elevated withdrawal severity scores did not change significantly with age. However, patients aged 60 years and older had increased risk for delirium (adjusted odds ratio [OR], 4.7; 95% confidence interval [CI], 1.5-15.0; P = .008), falls (OR, 3.1; 95% CI, 0.9-11.2; P = .08), and transient dependency in 2 or more activities of daily living (OR, 5.8; 95% CI, 2.9-11.7; P < .001). As age increased, there were significant increases in length of stay (P < .001) and frequency of discharge to an extended care facility (P < .001).
Although alcohol withdrawal severity scores and benzodiazepine requirements were similar across age groups, patients aged 60 years and older were at increased risk for cognitive and functional impairment during withdrawal. These findings support recommendations that older patients with alcohol withdrawal are best treated in closely supervised settings.
早期识别酒精依赖患者中发生严重或复杂酒精戒断的风险增加，将改善分诊和治疗。然而，年龄在预测酒精戒断结果中的作用尚未得到充分研究。
评估年龄对酒精戒断严重程度、病程及并发症的影响。
我们对1992年9月至1994年8月期间因酒精戒断入院的284例住院患者进行了一项回顾性队列研究。结果包括通过修订的酒精临床戒断评估量表测量的酒精戒断严重程度、苯二氮䓬类药物治疗的剂量和持续时间以及戒断期间的并发症。
初始和最大戒断严重程度评分、苯二氮䓬类药物给药量以及因戒断严重程度评分升高而进行的苯二氮䓬类药物治疗持续时间并未随年龄显著变化。然而，60岁及以上的患者谵妄风险增加（调整优势比[OR]，4.7；95%置信区间[CI]，1.5 - 15.0；P = 0.008）、跌倒风险增加（OR，3.1；95% CI，0.9 - 11.2；P = 0.08）以及在两项或更多日常生活活动中出现短暂依赖的风险增加（OR，5.8；95% CI，2.9 - 11.7；P < 0.001）。随着年龄增长，住院时间（P < 0.001）和转至长期护理机构的出院频率（P < 0.001）显著增加。
尽管各年龄组的酒精戒断严重程度评分和苯二氮䓬类药物需求相似，但60岁及以上的患者在戒断期间发生认知和功能损害的风险增加。这些发现支持了以下建议，即老年酒精戒断患者最好在密切监督的环境中接受治疗。
