TRIAL TO REDUCE DELIRIUM IN AGED POST ACUTE PATIENTS

减少老年急性期患者谵妄的试验

• 批准号: 6509709
• 负责人: EDWARD R MARCANTONIO
• 金额: $ 44.6万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-05-01 至 2004-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6509709
• 关键词: anxiety; behavioral /social science research tag; body fluid balance therapy; body water dehydration; clinical research; clinical trials; cognition disorders; delusions; drug adverse effect; extended care facility; functional ability; geriatric nursing; health services research tag; human old age (65+); human subject; human therapy evaluation; medical complication; medical rehabilitation related tag; nursing intervention; organic brain syndrome; patient care management; posthospitalization care; postoperative state; rehabilitation

Common, morbid, and costly, delirium affects one third of hospitalized elders, and plays a central role in the cascade of adverse events that leads to functional decline and loss of independence. Moreover, as acute care stays continue to shorten and evidence mounts that delirium may persist for many weeks, concern about delirium can no longer be confined to the hospital. Preliminary data from our own work and others suggest that 25 percent of elders admitted to post-acute care facilities are delirious, and that two-thirds of these remain delirious one month later. It is our hypothesis that persistent delirium exerts a significant negative influence on functional recovery in post-acute care. To test this, we propose a randomized controlled interventional trial involving 500 subjects admitted with delirium at four post-acute facilities. A Delirium Abatement Program (DAP) will be developed using specialized protocols for: 1) diagnosing delirium, 2) treating common causes of delirium, 3) preventing complications of delirium, and 4) restoring function. The DAP will be implemented at two intervention facilities under the supervision of Drs. Marcantonio and Murphy. Two additional facilities, matched by demographic, facility, and clinical characteristics to the intervention sites, will serve as controls. To assess the effectiveness of the DAP, subjects will undergo blinded assessments of delirium, cognitive, and functional status at intake, weekly while in the post-acute facilities, and at one, three, and six months after admission. Using bivariable, multivariable, and longitudinal analyses, we will assess the impact of the DAP on the prevalence and severity of delirium, and the rate of ADL functional improvement two weeks and one month after post-acute admission. We will also assess the long term impact of our intervention on ADL functional recovery three and six months after post-acute admission. This study will be the first to examine the natural history and impact of persistent delirium in-the post-acute setting. If the DAP is successful in reducing delirium and improving functional recovery, our findings will serve as a model of a targeted approach to improve the care of elders in the post-acute setting.

常见，病态且昂贵的ir妄影响住院的长辈的三分之一，并且在一系列不良事件中起着核心作用，导致功能下降和独立性丧失。 此外，随着急性护理的继续缩短，并且有证据表明，deli妄可能持续数周，对ir妄的担忧不再局限于医院。我们自己工作和其他人的初步数据表明，承认急性护理机构的长老中有25％是幻想的，一个月后，其中三分之二仍然很狡猾。 我们的假设是，持续的ir妄对急性后护理的功能恢复产生了重大的负面影响。 为了测试这一点，我们提出了一项随机对照的介入试验，涉及在四个急性后设施中接受ir妄的500名受试者。 将使用专业方案来开发一个ir妄计划（DAP）：1）诊断del妄，2）治疗del妄的常见原因，3）防止del妄并发症； 4）恢复功能。 DAP将在DR的监督下在两个干预设施中实施。 Marcantonio和Murphy。 由人口统计，设施和临床特征与干预地点相匹配的另外两个设施将用作控制。 为了评估DAP的有效性，受试者将在摄入量时对ir妄，认知和功能状态进行盲目评估，每周在急性后的设施中，并在入院后一个，三个月和六个月。使用双变量，多变量和纵向分析，我们将评估DAP对ir妄的患病率和严重程度的影响，以及急性入院后两个星期零一个月的ADL功能改善率。 我们还将评估急性入院后三个月和六个月的干预对ADL功能恢复的长期影响。 这项研究将是第一个研究急性后环境持续性del妄的自然历史和影响的一项。 如果DAP成功地减少了ir妄和改善功能恢复，我们的发现将成为有针对性方法的模型，以改善急性后环境中长老的护理。