Delirium and Survival in Post-Acute Care

描述（由申请人提供）：本申请的主要目标是通过添加和扩展现有的PAC谵妄患者临床特征和结局数据库，增加有关急性期后护理（PAC）环境中谵妄症状和后遗症的知识。在过去的4年里，我们一直在进行一项随机临床试验（RCT）的谵妄减轻计划（DAP）的患者承认八个波士顿地区急性后熟练护理设施的支持下，国家老龄化研究所。我们筛选了8198名住院患者，并招募了457名受试者（平均年龄84岁，65%为女性）进入我们的试验，使其成为迄今为止最大的谵妄患者队列研究。本申请的目的是获得额外的次要分析（不在原始RCT的主要或次要结局中）的支持，这些分析为急性期后护理中谵妄的临床流行病学提供信息。本申请的具体目的是：（1）通过与国家死亡指数联系，获得我们RCT中入组患者的纵向生存信息，（2）检查持续性谵妄、谵妄症状和谵妄严重程度与急性入院后谵妄长期（4年）生存率的相关性。此外，我们将进行探索性分析，探讨持续性谵妄和死亡率之间关系的性质，密切研究特定死亡原因的差异，以及合并症可能的调节或介导作用。实现这些目标将大大有助于了解谵妄在PAC设置，并可能推广到其他设置。我们的研究团队包括参与正在进行的RCT的高级成员。因此，我们熟悉数据的背景和结构，并且已经基于该数据集进行了一些二次分析。

DESCRIPTION (provided by applicant): The main goal of this application is to add to the body of knowledge regarding the symptoms and sequelae of delirium in the post-acute care (PAC) setting by adding to and expanding upon an existing database of clinical characteristics and outcomes of patients admitted to PAC with delirium. Over the past 4 years we have been conducting a randomized clinical trial (RCT) of a Delirium Abatement Program (DAP) for patients admitted to eight Boston area post-acute skilled nursing facilities with the support of the National Institute on Aging. We have screened 8198 admissions, and enrolled 457 subjects (mean age 84 years, 65% women) into our trial, making it by far the largest cohort of delirious patients ever enrolled in a research study. Our goal with this application is to obtain support for additional secondary analyses (not among the primary or secondary outcomes of the original RCT) that inform the clinical epidemiology of delirium in post-acute care. The specific aims of this application are to: (1) Obtain longitudinal survival information on patients enrolled in our RCT by linking with the National Death Index, (2) Examine the association of persistent delirium, delirium symptoms, and delirium severity on long-term (4 year) survival following post-acute admission with delirium. Additionally, we will pursue exploratory analyses probing the nature of the relationship of persistent delirium and mortality, examining closely differences in specific causes of death, and the possible moderating or mediating role of comorbidity. Addressing these aims will contribute substantially to the understanding of delirium in the PAC setting, and may be generalizable to other settings. Our study team includes the senior members participating in the ongoing RCT. Therefore, we are familiar with the context and structure of the data, and have already produced some secondary analyses based on this dataset.