The effects of a targeted multicomponent delirium intervention on postdischarge outcomes for hospitalized older adults
The effects of a targeted multicomponent delirium intervention on postdischarge outcomes for hospitalized older adults
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DOI：
10.1016/s0002-9343(02)01569-3
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发表时间：
2003-04-01
影响因子：
5.9
通讯作者：
Inouye, SK
中科院分区：
文献类型：
--
作者：
Bogardus, ST;Desai, MA;Inouye, SK
目得：我们试图确定是否有针对性的危险因素谵妄的多组分医院为基础的干预措施有任何影响患者的结局6个月后。方法：我们研究了705例年龄在70岁或以上的患者已被纳入一个多组分干预的对照试验在一个学术医疗中心，谁存活了至少6个月后住院。结果包括自测健康、功能状态、尿失禁、抑郁、认知状态、谵妄、家庭健康访视、家庭主妇访视、再住院和疗养院安置。总体而言，干预组和对照组在10个结局中的任何一个方面都没有差异，干预组尿失禁发生率略低（30% [103/344] vs. 37% [132/354]，P = 0.02）。在高危患者中，干预组的自评健康状况较好（基线时自评健康状况差/差的患者中，P < 0.001），功能状况较好（基线时功能障碍的患者中，P < 0.001）。有没有影响，在其他六个高风险的亚组，包括认知和行为的结果（Folstein迷你精神状态检查，老年抑郁量表，失禁，谵妄）和卫生保健utilization.CONCLUSION：在组作为一个整体，我们无法确定一个持久的有益效果的多组分干预，虽然进一步努力，以确定适当的亚组有针对性的干预措施可能是值得的。出院后需要采取其他策略，以防止易感老年人病情恶化。(C)2003年，Excerpta Medica Inc.
PURPOSE: We sought to determine whether a multicomponent hospital-based intervention targeted toward risk factors for delirium had any effect on patient outcomes 6 months later.METHODS: We studied 705 patients aged 70 years or older who had been enrolled in a controlled trial of a multicomponent intervention at an academic medical center and who survived for at least 6 months after hospitalization. Outcomes included self-rated health, functional status, incontinence, depression, cognitive status, delirium, home health visits, homemaker visits, rehospitalization, and nursing home placement.RESULTS: Overall, there were no differences between the intervention and control groups for any of the 10 outcomes, except that incontinence was slightly less common in the intervention group (30% [103/344] vs. 37% [132/354], P = 0.02). Among high-risk patients, those in the intervention group had better self-rated health (among those with poor/bad self-rated health at baseline, P < 0.001) and better functional status (among those with baseline functional impairment, P < 0.001). There were no effects in the other six high-risk subgroups, including cognitive and behavioral outcomes (Folstein Mini-Mental State Examination, Geriatric Depression Scale, incontinence, and delirium) and health care utilization.CONCLUSION: In the group as a whole, we were unable to identify a lasting beneficial effect of the multicomponent intervention, although further efforts to identify appropriate subgroups for targeted interventions may be worthwhile. Other strategies are needed after hospital discharge to deter deterioration in susceptible elderly people. (C) 2003 by Excerpta Medica Inc.