George J, Bleasdale S, Singleton S J
Department of Medicine for the Elderly, Cumberland Infirmary, Carlisle, UK.
Age Ageing. 1997 Nov;26(6):423-7. doi: 10.1093/ageing/26.6.423.
delirium is common and is associated with a high early mortality, but less is known about the longer term prognosis.
case-controlled prospective study.
all relevant wards were contacted weekly by a research nurse and the nurses were asked to report all patients presenting with confusion. Patients satisfying the American Psychiatric Association's Diagnostic and Statistical Manual III criteria were included. The diagnosis of delirium was confirmed by a consultant physician. Delirious patients were then followed-up throughout their hospital admission to ascertain the cause of their delirium, and assessed for visual and hearing impairment. The patients were assessed again at 6 and 12 months. Control patients, who were in hospital at the same time and on similar wards, but were not confused, were also examined and followed-up.
171 patients with delirium were identified (78 men and 93 women, mean age 81 years). The commonest cause of delirium was infection (34% of cases), but in 25% there were multiple equally contributory causes. Vision and hearing impairment was significantly more common in patients with delirium [odds ratio (OR) 12.62; confidence intervals (CI) 2.86-114.04, P < 0.001). After 1 year, patients presenting with delirium had an increased mortality (OR 2.30; 95% CI 1.25-4.35, P = 0.006), an increased institutionalization rate (OR 4.53; 95% CI 1.80-13.56, P = 0.001) and an increased likelihood of having been re-admitted (OR 2.05; 95% CI 1.19-3.54, P = 0.008).
delirium has a poor long-term prognosis and may be a marker for functional deterioration and decline in elderly people.
谵妄很常见，且与早期高死亡率相关，但对其长期预后了解较少。
病例对照前瞻性研究。
研究护士每周联系所有相关病房，要求护士报告所有出现意识模糊的患者。纳入符合美国精神病学协会《诊断与统计手册》第三版标准的患者。谵妄诊断由一位会诊医师确认。然后对谵妄患者在整个住院期间进行随访，以确定其谵妄病因，并评估视力和听力损害情况。在6个月和12个月时再次对患者进行评估。同时选取在同一时间、相似病房住院但未出现意识模糊的对照患者进行检查和随访。
共识别出171例谵妄患者（78例男性和93例女性，平均年龄81岁）。谵妄最常见的病因是感染（34%的病例），但25%的病例有多种同等作用的病因。谵妄患者中视力和听力损害明显更常见[优势比（OR）12.62；置信区间（CI）2.86 - 114.04，P < 0.001]。1年后，出现谵妄的患者死亡率增加（OR 2.30；95% CI 1.25 - 4.35，P = 0.006），入住机构的比例增加（OR 4.53；95% CI 1.80 - 13.56，P = 0.001），再次入院的可能性增加（OR 2.05；95% CI 1.19 - 3.54，P = 0.008）。
谵妄的长期预后较差，可能是老年人功能恶化和衰退的一个标志。
