PROGNOSIS AFTER HOSPITAL DISCHARGE OF OLDER MEDICAL PATIENTS WITH DELIRIUM
PROGNOSIS AFTER HOSPITAL DISCHARGE OF OLDER MEDICAL PATIENTS WITH DELIRIUM
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DOI：
10.1111/j.1532-5415.1992.tb02111.x
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发表时间：
1992-06-01
影响因子：
6.3
通讯作者：
KAPOOR, WN
中科院分区：
文献类型：
--
作者：
FRANCIS, J;KAPOOR, WN
目的：为了确定老年患者的生存率，功能独立性和认知能力2年后的事件delirium.Design：描述性队列研究。设置：普通内科病房的教学hospital.Patients：229名连续患者年龄70岁或以上，入院前一直居住在社区。 50例患者符合谵妄标准（病例）;将这些患者与无谵妄的患者（对照组）进行比较。 223例患者存活住院治疗（46例，177对照），其中92%的人进行了随访大于或等于2 years.Main Outcome Measures：生命状态，居住地，日常生活活动（ADL），和认知能力的患者或护理人员出院后2年的电话采访。 独立的社区生活被定义为一个机构外的生存，没有依赖于任何四个基本的日常生活能力（洗澡，穿衣，转让，吃）。结果：在整个人口的两年死亡率为39%的情况下，23%的控制（相对危险度1.82，95%置信区间1.04-3.19）。 谵妄确定了那些有丧失独立社区生活风险的患者，即使在调整了潜在的混杂变量后（调整后的比值比为2.56，95%置信区间为1.10-5.91）。 在一个子集的患者高基线性能的后续认知测试显示，谵妄的情况下，比controls.Conclusions（P = 0.023）的性能下降更大：谵妄确定老年患者的死亡或丧失独立的风险。 谵妄也可能识别出患者未来认知能力下降的风险。
Objective: To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium.Design: Descriptive cohort study.Setting: General medical wards of a teaching hospital.Patients: Two hundred twenty-nine consecutive patients aged 70 years or older who had been community-dwelling prior to admission. Fifty patients met criteria for delirium (cases); these were compared to patients without delirium (controls). Two-hundred twenty-three patients survived hospitalization (46 cases, 177 controls) Of these, 92% were followed greater-than-or-equal-to 2 years.Main Outcome Measures: Vital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or care-givers 2 years after discharge. Independent community living was defined as survivorship outside of an institution and without dependence in any of four basic ADL (bathing, dressing, transfers, eating).Results: Two-year mortality in the entire population was 39% for cases and 23% for controls (relative risk 1.82, 95% confidence interval 1.04-3.19). Delirium identified those patients at risk for loss of independent community living, even after adjustment for potential confounding variables (adjusted odds ratio 2.56, 95% confidence interval 1.10-5.91). Follow-up cognitive testing in a subset of patients with high baseline performance revealed a greater decline in performance among cases of delirium than controls (P = 0.023).Conclusions: Delirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.