Patient Outcomes After Delirium Screening and Incident Alzheimer's Disease or Related Dementias in Skilled Nursing Facilities.
Patient Outcomes After Delirium Screening and Incident Alzheimer's Disease or Related Dementias in Skilled Nursing Facilities.
复制标题
熟练护理机构中谵妄筛查和阿尔茨海默病或相关痴呆症事件后的患者结果。
DOI：
10.1007/s11606-022-07760-6
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发表时间：
2023
影响因子：
5.7
通讯作者：
Briesacher,BeckyA
中科院分区：
文献类型：
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作者：
Vo,QuynhT;Koethe,Benjamin;Holmes,Sarah;Simoni-Wastila,Linda;Briesacher,BeckyA
目的比较新入院的熟练护理设施(SNF)患者的长期预后。设计、设置和参与者从2015-2016年间对从医院进入SNF且住院至少14天(n=100,832)的医疗保险受益者进行了一项回溯性队列研究。主要措施包括：返家、重新入院、长期护理机构入院结果精神错乱患者出院的可能性与诊断为ADRD的患者相同(HR：0.63，95%CI：0.59，0.67；HR：0.65，95%CI：0.64，0.67)。既有妄想症又有ADRD的患者出院的可能性较小(HR：0.49，95%CI：0.47，0.52)，死亡风险较高(HR：1.30，95%CI：1.17，1.45)。无论筛查状态如何，ADRD患者长期转移养老院护理的风险增加(HR：1.66，95%CI：1.63，1.70；HR：1.76，95%CI：1.69，1.82)。神志不清且无ADRD的患者转移到长期养老院护理的风险增加(HR：1.25，95%CI：1.18，1.33)。无ADRD的精神分裂症筛查阳性组的病死率明显高于无妄想组和无ADRD组(HR：2.35，95%CI：2.11，2.61)。结论无论ADRD的诊断是否发生，均可增加入院后100天内死亡和转入长期护理的风险。精神错乱和/或ADRD的患者也不太可能出院回家。我们的研究建立在证据的基础上，即精神错乱在老年人中是重要的，因为它与负面结果相关。
BackgroundThe extent to which a positive delirium screening and new diagnosis of Alzheimer’s disease or related dementias (ADRD) increases the risk for re-hospitalization, long-term nursing home placement, and death remains unknown.ObjectiveTo compare long-term outcomes among newly admitted skilled nursing facility (SNF) patients with delirium, incident ADRD, and both conditions.Design, Setting, and ParticipantsA retrospective cohort study of Medicare beneficiaries who entered a SNF from hospital with a minimum 14-day stay (n= 100,832) from 2015 to 2016.Main MeasuresReturn to home, hospital readmission, admission to a long-term care facility, or death.Key ResultsPatients with delirium were as likely to be discharged home as patients diagnosed with ADRD (HR: 0.63, 95% CI: 0.59, 0.67; HR: 0.65, 95% CI: 0.64, 0.67). Patients with both delirium and ADRD were less likely to be discharged home (HR: 0.49, 95% CI: 0.47, 0.52) and showed increased risk of death (HR: 1.30, 95% CI: 1.17, 1.45). Patients with ADRD, regardless of delirium screening status, had increased risk for long-term nursing home care transfer (HR: 1.66, 95% CI: 1.63, 1.70; HR: 1.76, 95% CI: 1.69, 1.82). Patients with delirium and no ADRD showed increased risk of transfer to long-term nursing home care (HR: 1.25, 95% CI: 1.18, 1.33). The rate of deaths was higher among patients who screened positive for delirium without ADRD compared to the no delirium and no ADRD groups (HR: 2.35, 95% CI: 2.11, 2.61).ConclusionA positive delirium screening increased risk of death and transfer to long-term care in the first 100 days after admission regardless of incident ADRD diagnosis. Patients with delirium and/or ADRD also are less likely to be discharged home. Our study builds on the evidence base that delirium is important to address in older adults as it is associated with negative outcomes.