Association between psychomotor activity delirium subtypes and mortality among newly admitted postacute facility patients
Association between psychomotor activity delirium subtypes and mortality among newly admitted postacute facility patients
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DOI：
10.1093/gerona/62.2.174
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发表时间：
2007-02-01
影响因子：
5.1
通讯作者：
Marcantonio, Edward R.
中科院分区：
文献类型：
--
作者：
Kiely, Dan K.;Jones, Richard N.;Marcantonio, Edward R.
背景谵妄在住院的老年人中很常见，可能持续数月。因此，谵妄对独立性的不利影响经常发生在急性期后护理（PAC）环境中。精神障碍亚型对谵妄的影响尚不确定。本研究的目的是探讨精神活动性谵妄亚型与457例新入院的谵妄PAC患者1年死亡率之间的关系。患者在急性住院后进入PAC设施时进行谵妄筛查，并招募了“意识模糊评估方法”定义的谵妄患者。使用记忆性谵妄评估量表评估精神活动，并将患者分为谵妄亚型（多动、少动、混合或正常）。一年死亡率数据来自国家死亡指数。采用Kaplan-Meier生存分析和比例风险分析，以正常精神活动为参照，使用指示变量（虚拟变量）。精神活动正常组的1年死亡率最低，其次是多动组、混合组、低动组，依次递增。与年龄、性别、合并症、痴呆和谵妄严重程度无关，在1年随访期间，活动减退患者的死亡率是精神活动正常患者的1.60倍（95%置信区间[CI]，1.09-2.35）。多动（危险比= 1.30; 95%CI，0.73-2.31）和混合（危险比= 1.25; 95%CI，0.72-2.17）精神病组相对于正常精神病行为组的风险无显著增加。所有三种精神障碍亚型在1年随访期间相对于正常精神障碍组的死亡风险升高，尽管活动减退组的死亡风险最高，并且是唯一一个相对于正常组具有统计学显著升高风险的组。
Background. Delirium is common among hospitalized elders and may persist for months. Therefore, the adverse impact of delirium on independence often occurs in the postacute care (PAC) setting. The effect of psychomotor subtypes on delirium remains uncertain. The purpose of this study is to examine the association between psychomotor activity delirium subtypes and 1-year mortality among 457 newly admitted delirious PAC patients.Methods. Patients were screened for delirium on admission to PAC facilities after an acute hospitalization, and patients with "Confusion Assessment Method"-defined delirium were enrolled. Psychomotor activity was assessed using the Memorial Delirium Assessment Scale, and patients were classified as to their delirium subtype (hyperactive, hypoactive, mixed, or normal). One-year mortality data were obtained from the National Death Index. A Kaplan-Meier survival analysis and a proportional hazards analysis using indicator (dummy) variables with normal psychomotor activity as the referent were performed.Results. The normal psychomotor activity group had the lowest 1-year mortality rate, followed by the hyperactive, mixed, then hypoactive groups in increasing order. Independent of age, gender, comorbidity, dementia, and delirium severity, hypoactive patients were 1.60 (95% confidence interval [CI], 1.09-2.35) times more likely to die during the 1-year follow-up period than were patients with normal psychomotor activity. The hyperactive (hazard ratio= 1.30; 95% CI, 0.73-2.31) and mixed (hazard ratio= 1.25; 95% CI, 0.72-2.17) psychomotor groups had nonsignificant elevated risks relative to the normal psychomotor behavior group.Conclusions. All three psychomotor disturbance subtypes had an elevated risk of dying during the 1-year follow-up relative to the normal psychomotor group, though the hypoactive group had the highest mortality risk and was the only group with a statistically significantly elevated risk relative to the normal group.