Delirium superimposed on dementia in a community-dwelling managed care population: A 3-year retrospective study of occurrence, costs, and utilization
Delirium superimposed on dementia in a community-dwelling managed care population: A 3-year retrospective study of occurrence, costs, and utilization
复制标题
DOI：
10.1093/gerona/60.6.748
复制
发表时间：
2005-06-01
影响因子：
5.1
通讯作者：
Inouye, SK
中科院分区：
文献类型：
--
作者：
Fick, DM;Kolanowski, AM;Inouye, SK
背景资料。痴呆症是一个日益严重的公共卫生问题，也是众所周知的精神错乱的危险因素。然而，对社区居住人群中痴呆性精神错乱的研究知之甚少，本研究的目的是调查社区居住人群中痴呆性精神错乱的3年发生率、医疗服务利用情况和相关费用。我们使用了一项为期3年的横断面回顾设计，并使用了一个来自大型管理性医疗组织的管理数据库。选择了4个单独匹配的样本，每个样本699人，用于比较目的：痴呆症叠加妄想症(DSD)、单纯痴呆症、单纯妄想症，以及既没有妄想症也没有痴呆症的对照组。DSD的发生率是通过测量那些被诊断为痴呆症的人来计算的，这些痴呆症的编码也是按照国际疾病分类第九版临床修改(ICD-9 CM)编码的，用于治疗痴呆症或痴呆。在管理性保健组织中年龄在65岁或以上的76,688人的总样本中，7347人(10%)被编码为痴呆症，另有763人(1%)被编码为单独精神错乱。在7347名痴呆症患者中，976人(13%)患有DSD，占总样本的1.3%。对总成本进行对数转换后，对多个协变量进行调整。DSD组调整后的平均总医疗费用仍然显著高于所有其他组。这项研究首次报道了社区居民中DSD的发生率，并证明了与DSD相关的可观的医疗费用和使用率。
Background. Dementia is a growing public health problem and a well-described risk factor for delirium. Yet little is known about delirium superimposed on dementia in community-dwelling populations, The purpose of this study was to examine the 3-year occurrence, healthcare utilization, and costs associated with delirium superimposed on dementia in community-dwelling persons.Methods. We used a 3-year cross-sectional, retrospective design with an administrative database from a large managed care organization. Four individually matched samples of 699 individuals each were selected for comparison purposes; delirium superimposed on dementia (DSD), dementia alone, delirium alone, and a control group with neither delirium nor dementia. The occurrence rate of DSD was calculated by measuring those individuals with a dementia diagnosis that were also coded with an International Classification of Diseases, Ninth Edition Clinical Modification (ICD-9 CM) code for delirium or delirium with dementia.Results. Of the total sample of 76,688 persons aged 65 years or older in the managed care organization, 7347 (10%) were coded as having dementia, and an additional 763 (1%) as having delirium alone. Among the 7347 with dementia, 976 (13%) had DSD, representing 1.3% of the total sample. After log transformation of total costs and adjustment for multiple covariates. the adjusted mean total health care costs remained significantly higher for the DSD group than for all other groups.Conclusions. This study is the first to report the occurrence rate of DSD in a community-dwelling population, and to demonstrate the substantial health care costs and utilization associated with DSD.