Risk Factors and Time Course of Incident Delirium Among Older Adults in the Emergency Department (ED)

急诊科 (ED) 老年人发生谵妄的危险因素和时间进程

• 批准号: 10726180
• 负责人: Rachel Michelle Skains
• 金额: $ 14.85万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10726180
• 关键词: Accident and Emergency department; Accreditation; Acute; Admission activity; Adult; Aging; Alzheimer disease screening; Area Under Curve; Assessment tool; Award; Biometry; Caring; Cognition; Cognitive; Continuity of Patient Care; Data; Delirium; Dementia; Detection; Development; Discipline of Nursing; Early Intervention; Early identification; Elder Abuse; Elderly; Electronic Health Record; Eligibility Determination; Emergency Care; Emergency Department Physician; Emergency Department patient; Emergency Nursing; Emergency Situation; Emergency department visit; Environment; Family; Future; Geriatrics; Goals; Guidelines; Health; Hospitalization; Hospitals; Hour; Impaired cognition; Incidence; Infrastructure; Inpatients; Intervention; Interview; K-Series Research Career Programs; Logistic Regressions; Long-Term Care for Elderly; Mentorship; Modeling; National Institute on Aging; Nursing Assessment; Nutritional; Outcome; Patient Admission; Patients; Performance; Prevention; Prevention strategy; Preventive; Prognosis; Prospective, cohort study; Provider; Recommendation; Research; Research Assistant; Research Design; Research Personnel; Risk; Risk Assessment; Risk Factors; Severities; Time; Triage; Visit; Work; acute care; adverse outcome; aged; aging brain; confusion assessment method; disability; effective therapy; falls; frailty; high risk; human old age (65+); improved; indexing; informant; innovation; instrument; nursing administration; prevent; programs; risk stratification; screening; skills; social; tool; virtual

PROJECT SUMMARY / ABSTRACT Adults aged 65 and older represent ~23 million (18%) annual Emergency Department (ED) visits. Delirium, an acute, fluctuating change in cognition with numerous modifiable and nonmodifiable risk factors, is prevalent in up to 35% of older adults in the ED. However, the incidence and time course of ED delirium is currently unknown. Prevention is the only effective treatment, yet only 40% of delirium cases in hospitalized older adults can be prevented, making prediction and early recognition of patients at-risk of incident delirium – such as in the ED – vital. Unfortunately, ED providers fail to recognize up to 83% of delirium cases, which can lead to significant downstream consequences, such as ED revisits, falls, and hospitalizations. Thus, there is a critical need to identify older adults at highest-risk of delirium in the ED to facilitate early interventions. The overall objective of this proposal is to establish the incidence, time course, and risk factors of delirium during the ED stay, which is a critical prerequisite for implementing effective delirium prevention and management interventions. We will achieve this objective with the following three aims: (1) Determine the incidence and time course of ED delirium with validated detection tools, (2) Identify modifiable and nonmodifiable risk factors of incident ED delirium, and (3) Examine existing risk stratification screening instruments for incident ED delirium. We propose a prospective cohort study of older adults ≥65yo in a Level 1 accredited Geriatric ED. We will collect delirium and other cognitive impairment screenings on all patients ≥65yo at ED admission to establish baseline cognitive status. During the ED stay, patients will be screened for delirium at regular intervals to determine the incidence and time course of ED delirium. For admitted patients, delirium will continue to be assessed once per nursing shift during inpatient hospitalization. Using electronic health record data, we will examine modifiable and nonmodifiable risk factors for delirium in the ED and within 24- and 48- hrs of admission. Further, we will assess if recommended geriatric risk stratification instruments can predict incident ED delirium. Consistent with the goals of the “National Institute on Aging: Strategic Directions for Research, 2020-2025”, findings from this proposal will improve our understanding of the aging brain and its impact on the prevention, progression, and prognosis of ED delirium. Specifically, this work will have a positive impact on Geriatric ED care by identifying a subset of older adults at-risk for delirium. We will also establish the rate and risk factors for incident ED delirium, which will be the first steps in preventive strategies. During the award period, the candidate will acquire specific skills in aging research and benefit from interdisciplinary mentorship by accomplished geriatrics clinician-investigators. This study will serve as the basis for a K-award application by providing the groundwork and infrastructure for evaluating future delirium prevention and management strategies.

项目摘要/摘要 65岁及以上的成年人占急诊科(ED)年就诊人次的约2300万人次(18%)。精神错乱， 一种带有许多可改变和不可改变的危险因素的急性、波动的认知改变是普遍存在的。 在ED的老年人中，高达35%。然而，勃起功能障碍的发生率和时间进程目前是 未知。预防是唯一有效的治疗方法，但住院老年人中只有40%的精神错乱病例。 可以预防，预测和早期识别有偶发精神错乱风险的患者-例如在 埃德-至关重要。不幸的是，急诊室提供者无法识别高达83%的精神错乱病例，这可能导致显著的 下游后果，如ED复诊、跌倒和住院。因此，迫切需要 找出ED中精神错乱风险最高的老年人，以便进行早期干预。 这项建议的总体目标是确定精神错乱的发生率、时间进程和危险因素。 在急症室逗留期间，这是实施有效预防精神错乱和 管理干预。我们将通过以下三个目标实现这一目标：(1)确定 使用有效的检测工具确定ED妄想的发生率和时间进程，(2)识别可修改和不可修改 事件痴呆的危险因素，以及(3)检查现有的事件风险分层筛查工具 埃德精神错乱。我们建议在1级认证的老年ED中对老年人≥65yo进行前瞻性队列研究。 我们将收集所有患者在急诊室入院时的精神错乱和其他认知障碍筛查≥65yo 建立基线认知状态。在急诊科住院期间，会定期对病人进行精神错乱筛查。 目的：了解勃起功能障碍的发生率和时程。对于住院患者，精神错乱将继续 住院期间每个护理班次评估一次。使用电子健康记录数据，我们将 在急诊室和入院后24小时和48小时内检查可改变和不可改变的精神错乱危险因素。 此外，我们还将评估推荐的老年风险分层工具是否可以预测勃起功能障碍的发生。 与“国家老龄问题研究所：2020-2025年战略研究方向”的目标一致， 这一建议的发现将提高我们对大脑老化及其对预防的影响的理解， 勃起功能障碍的进展和预后。具体地说，这项工作将对老年急诊护理产生积极影响 通过识别一部分有精神错乱风险的老年人。我们还将确定以下比率和风险因素 这将是预防策略的第一步。在颁奖期间，候选人 将获得老龄化研究方面的特定技能，并受益于由已完成的 老年病临床医生-研究人员。这项研究将作为K奖申请的基础，通过提供 评估未来精神错乱预防和管理战略的基础和基础设施。