Incomplete functional recovery after delirium in elderly people: a prospective cohort study.
Incomplete functional recovery after delirium in elderly people: a prospective cohort study.
复制标题
老年人del妄后的功能恢复不完全：一项前瞻性队列研究。
DOI：
10.1186/1471-2318-5-5
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发表时间：
2005-03-17
期刊：
影响因子：
4.1
通讯作者：
Rockwood, Kenneth
中科院分区：
文献类型：
--
作者：
Andrew, Melissa K;Freter, Susan H;Rockwood, Kenneth
谵妄往往有一个穷人的结果，但为什么有些人有不完全恢复还不清楚。我们的目的是确定与谵妄后短期（出院）和长期（6个月）功能不完全恢复相关的因素。在一项前瞻性队列研究中，老年医学服务机构对老年谵妄患者进行了基线、出院和6个月时的功能评估。在77例患者中，已知71例患者在6个月时的生命和功能状态，其中21例（30%）死亡。功能恢复不完全，定义为与病前状态相比，Barthel指数下降≥10分，50名幸存者中有27名（54%）。与出院时死亡或功能丧失相关的因素是虚弱、无躁动（活动减退性谵妄）、心脏原因和治疗服务对谵妄的认识不足。虚弱、药物以外的原因以及治疗服务对谵妄的认识不足与6个月时的死亡或功能恢复不良相关。先前存在的虚弱，谵妄的心脏原因，以及治疗医生早期识别不佳与更差的结局相关。许多医生认为谵妄的不良后果是棘手的。虽然在某种程度上这可能是真的，但更熟练的护理是他们掌握的潜在补救措施。
Delirium often has a poor outcome, but why some people have incomplete recovery is not well understood. Our objective was to identify factors associated with short-term (by discharge) and long-term (by 6 month) incomplete recovery of function following delirium. In a prospective cohort study of elderly patients with delirium seen by geriatric medicine services, function was assessed at baseline, at hospital discharge and at six months. Of 77 patients, vital and functional status at 6 months was known for 71, of whom 21 (30%) had died. Incomplete functional recovery, defined as ≥10 point decline in the Barthel Index, compared to pre-morbid status, was present in 27 (54%) of the 50 survivors. Factors associated with death or loss of function at hospital discharge were frailty, absence of agitation (hypoactive delirium), a cardiac cause and poor recognition of delirium by the treating service. Frailty, causes other than medications, and poor recognition of delirium by the treating service were associated with death or poor functional recovery at 6 months. Pre-existing frailty, cardiac cause of delirium, and poor early recognition by treating physicians are associated with worse outcomes. Many physicians view the adverse outcomes of delirium as intractable. While in some measure this might be true, more skilled care is a potential remedy within their grasp.