Pain and delirium in people with dementia in the acute general hospital setting.
Pain and delirium in people with dementia in the acute general hospital setting.
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DOI：
10.1093/ageing/afy112
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发表时间：
2018-11-01
期刊：
影响因子：
6.7
通讯作者：
Sampson EL
中科院分区：
文献类型：
--
作者：
Feast AR;White N;Lord K;Kupeli N;Vickerstaff V;Sampson EL
疼痛和精神错乱在住院的痴呆症患者中很常见。这些疾病往往得不到充分的诊断和治疗。疼痛被认为是导致精神错乱的原因之一，但这种联系在这种情况下还没有被研究过。目的：探讨痴呆症患者入院时及入院期间疼痛与神志不清的关系。观察性前瞻性纵向队列数据的探索性二次分析。英国的两家急诊医院。230名≥70岁的参与者接受了痴呆症严重程度、精神错乱(混淆评估法)、疼痛(晚期痴呆症疼痛评估)量表和止痛药处方的评估。Logistic回归和线性回归利用横断面数据探讨了疼痛和精神错乱之间的关系。在住院期间，49%的参与者出现休息时的疼痛，26%的参与者出现活动时的疼痛。15%的参与者出现偶发性精神错乱，42%的人在至少两次评估中仍然神志不清。在35%神志不清且不能自我报告疼痛的参与者中，33%的参与者在休息时经历过疼痛，56%的参与者在活动时经历过疼痛。在休息时经历疼痛的参与者神志不清的几率是后者的3.26倍(95%可信区间为1.03-10.25，P=0.044)。研究发现，休息时疼痛与精神错乱之间存在关联，这表明疼痛可能是导致精神错乱的一个危险因素。由于疼痛和精神错乱在住院期间持续存在和发展，因此需要定期进行疼痛和精神错乱的评估，以有效地管理疼痛和精神错乱。
Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Exploratory secondary analysis of observational prospective longitudinal cohort data. Two acute hospitals in the UK. Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.
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影响因子：
4
作者：
Kupeli, Nuriye;Vickerstaff, Victoria;Sampson, Elizabeth L.
通讯作者：
Sampson, Elizabeth L.
影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
影响因子：
6.7
作者：
HODKINSON H M
通讯作者：
HODKINSON H M
影响因子：
4.1
作者：
Scott, Sharon;Jones, Louise;Sampson, Elizabeth L.
通讯作者：
Sampson, Elizabeth L.
影响因子：
4
作者：
White N;Leurent B;Lord K;Scott S;Jones L;Sampson EL
通讯作者：
Sampson EL