A multicomponent intervention to prevent delirium in hospitalized older patients
A multicomponent intervention to prevent delirium in hospitalized older patients
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DOI：
10.1056/nejm199903043400901
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发表时间：
1999-03-04
影响因子：
158.5
通讯作者：
Cooney, LW
中科院分区：
文献类型：
--
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
背景由于在住院老年患者谵妄是与不良后果，我们评估的有效性的多组分战略，为预防delirium.Methods我们研究了852例患者70岁或以上的人已被录取到全科医学服务在教学医院。通过前瞻性匹配策略，从一个干预单位和两个普通护理单位招募患者。干预措施包括管理谵妄六个风险因素的标准化方案：认知障碍、睡眠剥夺、不动、视力障碍、听力障碍和脱水。谵妄，主要的结果，每天进行评估，直到discharge.Results谵妄开发的干预组的9.9%，相比之下，15.0%的常规护理组（匹配的比值比，0.60; 95%的置信区间，0.39至0.92）。干预组的谵妄总天数（105 vs. 161，P=0.02）和总发作次数（62 vs. 90，P=0.03）显著较低。然而，谵妄的严重程度和复发率没有显着差异。干预的总体依从率为87%，每位患者的目标风险因素总数显著减少。干预与入院时认知障碍患者的认知障碍程度显著改善相关，并且与所有患者中睡眠药物使用率显著降低相关。在其他危险因素中，有改善不动，视力损害，听力importance.Conclusions的风险因素干预策略，我们研究的结果在住院老年患者谵妄发作的次数和持续时间显着减少的趋势。干预对谵妄的严重程度或复发率没有显着影响;这一发现表明，谵妄的一级预防可能是最有效的治疗策略。（N Engl J Med 1999;340：669-76.）(C)1999年，马萨诸塞州医学会。
Background Since in hospitalized older patients delirium is associated with poor outcomes, we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium.Methods We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital. Patients from one intervention unit and two usual-care units were enrolled by means of a prospective matching strategy. The intervention consisted of standardized protocols for the management of six risk factors for delirium: cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Delirium, the primary outcome, was assessed daily until discharge.Results Delirium developed in 9.9 percent of the intervention group, as compared with 15.0 percent of the usual-care group (matched odds ratio, 0.60; 95 percent confidence interval, 0.39 to 0.92). The total number of days with delirium (105 vs. 161, P=0.02) and the total number of episodes (62 vs. 90, P=0.03) were significantly lower in the intervention group. However, the severity of delirium and recurrence rates were not significantly different. The overall rate of adherence to the intervention was 87 percent, and the total number of targeted risk factors per patient was significantly reduced. Intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and with a significant reduction in the rate of use of sleep medications among all patients. Among the other risk factors, there were trends toward improvement in immobility, visual impairment, and hearing impairment.Conclusions The risk-factor intervention strategy that we studied resulted in significant reductions in the number and duration of episodes of delirium in hospitalized older patients. The intervention had no significant effect on the severity of delirium or on recurrence rates; this finding suggests that primary prevention of delirium is probably the most effective treatment strategy. (N Engl J Med 1999;340:669-76.) (C) 1999, Massachusetts Medical Society.