Subsyndromal Delirium in Older Long-Term Care Residents: Incidence, Risk Factors, and Outcomes
Subsyndromal Delirium in Older Long-Term Care Residents: Incidence, Risk Factors, and Outcomes
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DOI：
10.1111/j.1532-5415.2011.03595.x
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发表时间：
2011-10-01
影响因子：
6.3
通讯作者：
Belzile, Eric
中科院分区：
文献类型：
--
作者：
Cole, Martin G.;McCusker, Jane;Belzile, Eric
目的：确定长期护理(LTC)老年居民中亚综合征妄想症(SSD)的发生率、危险因素和预后，并探索使用更严格的SSD定义。设计：队列研究，每周重复评估长达6个月。设置：加拿大蒙特利尔和魁北克市的7家LTC设施。研究对象：104名65岁及以上的长期护理(LTC)居民，基线无妄想核心症状。测量：简易智力状态检查(MMSE)、迷惑评估方法(CAM)、妄想指数(DI)、等级痴呆量表(HDS)、痴呆量表(HDS)Barthel指数(BI)在基线时完成。每周重复MMSE、CAM和DI，为期6个月。SSD1需要一个或多个CAM核心症状；SSD2，一个更严格的定义，需要两个或多个CAM核心症状。6个月的结果是MMSE、HDS和BI下降；死亡率；以及综合结果。结果：104名居民中有68人患有SSD1。在生存分析中，每100人周的随访率为5.2(95%可信区间=4.1~6.7)。在多变量分析中，危险因素是男性和基线时更严重的认知损害。患有和不患有SSD1的居民之间的结果差异很小，没有统计学意义。SSD2的发病率较低(1.3，95%CI=0.9~1.9)，危险因素相似，认知结果显著差。结论：SSD2在老年LTC居民中具有重要的临床意义。尽管统计能力有限，但这些发现对LTC环境下的临床实践和研究具有潜在的重要意义。J am Geriatr Soc 59：1829-1836,2011。
OBJECTIVES: To determine the incidence of, risk factors for, and outcomes of subsyndromal delirium (SSD) in older long-term care (LTC) residents and, secondarily, to explore the use of a more-restrictive definition of SSD.DESIGN: Cohort study with repeated weekly assessments for up to 6 months.SETTING: Seven LTC facilities in Montreal and Quebec City, Canada.PARTICIPANTS: One hundred four LTC residents aged 65 and older and free of delirium core symptoms at baseline.MEASUREMENTS: The Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale (HDS), and Barthel Index (BI) were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. SSD1 required one or more CAM core symptoms; SSD2, a more-restrictive definition, required two or more CAM core symptoms. Outcomes at 6 months were decline on the MMSE, HDS, and BI; mortality; and a composite outcome.RESULTS: Sixty-eight of 104 residents had SSD1. In survival analysis, the incidence was 5.2 (95% confidence interval (CI) = 4.1-6.7) per 100 person-weeks of follow-up. In multivariate analysis, risk factors were male sex and more-severe cognitive impairment at baseline. The differences in outcomes between residents with and without SSD1 were small and not statistically significant. SSD2 had a lower incidence (1.3, 95% CI = 0.9-1.9), similar risk factors, and statistically significantly worse cognitive outcomes.CONCLUSION: SSD2 appears to be a clinically important disorder in older LTC residents. Despite limited statistical power, these findings have potentially important implications for clinical practice and research in LTC settings. J Am Geriatr Soc 59:1829-1836, 2011.