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.

项目总结/摘要 65岁及以上的成年人每年约有2300万（18%）急诊科（艾德）就诊。精神错乱， 一种急性的、波动性的认知变化，伴随着许多可改变和不可改变的风险因素， 在ED中高达35%的老年人中。然而，艾德谵妄的发病率和时间进程目前尚不清楚。 未知预防是唯一有效的治疗方法，但只有40%的住院老年人谵妄病例 可以预防，预测和早期识别有发生谵妄风险的患者-例如在 艾德-至关重要。不幸的是，艾德提供者未能识别高达83%的谵妄病例，这可能导致严重的 下游后果，如艾德复诊、福尔斯和住院。因此，迫切需要 确定艾德中谵妄风险最高的老年人，以促进早期干预。 本提案的总体目标是确定谵妄的发病率、时间进程和危险因素 在艾德住院期间，这是实施有效的谵妄预防的关键先决条件， 管理干预。我们将通过以下三个目标来实现这一目标：（1）确定 使用有效检测工具评估艾德谵妄的发病率和时间进程，（2）识别可改变和不可改变 事件艾德谵妄的危险因素，和（3）检查事件的现有危险分层筛选工具 艾德精神错乱。我们建议在1级认证的老年ED中对≥ 65岁的老年人进行前瞻性队列研究。 我们将收集所有≥ 65岁患者在艾德入院时的谵妄和其他认知障碍筛查结果， 建立基线认知状态。在艾德住院期间，将定期对患者进行谵妄筛查 确定艾德谵妄的发生率和时间进程。对于入院的患者，谵妄将继续 在住院期间，每个护理班次评估一次。使用电子健康记录数据，我们将 在艾德和入院后24小时和48小时内检查谵妄的可改变和不可改变的风险因素。 此外，我们将评估推荐的老年危险分层工具是否可以预测艾德谵妄事件。 根据“国家老龄问题研究所：2020-2025年研究战略方向”的目标， 这项提案的发现将提高我们对大脑老化及其对预防的影响的理解， 艾德谵妄的进展和预后。具体而言，这项工作将对老年艾德护理产生积极影响 通过确定一部分老年人有谵妄的风险。我们还将确定以下情况的发生率和风险因素： 事件艾德谵妄，这将是预防策略的第一步。在颁奖期间，候选人 将获得在老龄化研究的具体技能，并通过完成跨学科的指导受益 老年医学临床研究员。本研究将作为K奖申请的基础， 评估未来谵妄预防和管理策略的基础和基础设施。