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增加和扩展现有的PAC患者谵妄的临床特征和结果数据库，来增加关于急性期后护理（PAC）中谵妄症状和后遗症的知识体系。在过去的4年里，我们一直在进行一项谵妄缓解计划（DAP）的随机临床试验（RCT），研究对象是在美国国家老龄研究所的支持下，住在波士顿地区8家急性后熟练护理机构的患者。我们筛选了8198名入院者，并招募了457名受试者（平均年龄84岁，65%为女性）参加我们的试验，使其成为迄今为止参与研究的最大的谵妄患者队列。我们这一申请的目的是获得对附加的次要分析（不属于原始RCT的主要或次要结果）的支持，这些分析可以为急性后护理中谵妄的临床流行病学提供信息。本应用程序的具体目的是：(1)通过与国家死亡指数（National Death Index）相关联，获得纳入本随机对照试验的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谵妄入院后长期（4年）生存的关系。此外，我们将进行探索性分析，探究持续性谵妄和死亡率之间关系的本质，仔细检查具体死亡原因的差异，以及合并症可能的调节或中介作用。解决这些目标将大大有助于理解谵妄在PAC设置，并可能推广到其他设置。我们的研究团队包括参加正在进行的随机对照试验的资深成员。因此，我们熟悉数据的上下文和结构，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.