Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

被引:15
|
作者
Cirbus, Jamie [1 ]
MacLullich, Alasdair M. J. [2 ,3 ]
Noel, Christopher [1 ]
Ely, E. Wesley [4 ,5 ,6 ]
Chandrasekhar, Rameela [7 ]
Han, Jin H. [1 ,5 ,6 ]
机构
[1] Vanderbilt Univ, Dept Emergency Med, Med Ctr, 703 Oxford House, Nashville, TN 37232 USA
[2] Univ Edinburgh, Geriatr Med Unit, Edinburgh Delirium Res Grp, Edinburgh, Midlothian, Scotland
[3] Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Midlothian, Scotland
[4] Vanderbilt Univ, Dept Med, Div Allergy Pulm & Crit Care, Med Ctr, Nashville, TN 37232 USA
[5] Dept Vet Affairs Med Ctr, Tennessee Valley Hlth Care Ctr, Geriatr Res Educ & Clin Ctr, Nashville, TN 37212 USA
[6] Vanderbilt Univ, Ctr Qual Aging, Div Allergy Pulm & Crit Care, Med Ctr, Nashville, TN 37232 USA
[7] Vanderbilt Univ, Dept Biostat, Med Ctr, Nashville, TN 37232 USA
基金
美国国家卫生研究院;
关键词
delirium; etiology; subtypes; long-term function; long-term cognition; CONFUSION ASSESSMENT METHOD; INTENSIVE-CARE-UNIT; ELDERLY-PATIENTS; SEVERITY; MORTALITY; ASSOCIATION; VALIDATION; HOSPITALIZATION; QUESTIONNAIRE; DEMENTIA;
D O I
10.1017/S1041610218000777
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Background: Delirium is heterogeneous and can vary by etiology. Objectives: We sought to determine how delirium subtyped by etiology affected six-month function and cognition. Design: Prospective cohort study. Setting: Tertiary care, academic medical center. Participants: A total of 228 hospitalized patients > 65 years old were admitted from the emergency department (ED). Measurements: The modified Brief Confusion Assessment Method was used to determine delirium in the ED. Delirium etiology was determined by three trained physician reviewers using a Delirium Etiology checklist. Pre-illness and six-month function and cognition were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire and the short-form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Multiple linear regression was performed to determine if delirium etiology subtypes were associated with six-month function and cognition adjusted for baseline OARS ADL and IQCODE. Two-factor interactions were incorporated to determine pre-illness function or cognition-modified relationships between delirium subtypes and six-month function and cognition. Results: In patients with poorer pre-illness function only, delirium secondary to metabolic disturbance (beta coefficient = -2.9 points, 95%CI: -0.3 to -5.6) and organ dysfunction (beta coefficient = -4.3 points, 95%CI: -7.2 to -1.4) was significantly associated with poorer six-month function. In patients with intact cognition only, delirium secondary to central nervous system insults was significantly associated with poorer cognition (beta coefficient = 0.69, 95%CI: 0.19 to 1.20). Conclusions: Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.
引用
收藏
页码:267 / 276
页数:10
相关论文
共 50 条
  • [41] Fatigue and Physical Activity in Older Patients With Cancer: A Six-Month Follow-Up Study
    Luctkar-Flude, Marian
    Groll, Dianne
    Woodend, Kirsten
    Tranmer, Joan
    ONCOLOGY NURSING FORUM, 2009, 36 (02) : 194 - 202
  • [42] Trajectory and determinants of nutritional health in older patients during and six-month post-hospitalisation
    Chen, Cheryl C-H
    Tang, Siew T.
    Wang, Charlotte
    Huang, Guan-Hua
    JOURNAL OF CLINICAL NURSING, 2009, 18 (23) : 3299 - 3307
  • [43] Vital signs and impaired cognition in older emergency department patients: The APOP study
    Lucke, Jacinta A.
    de Gelder, Jelle
    Blomaard, Laura C.
    Heringhaus, Christian
    Alsma, Jelmer
    Schuit, Stephanie C. E. Klein Nagelvoort
    Brink, Anniek
    Anten, Sander
    Blauw, Gerard J.
    de Groot, Bas
    Mooijaart, Simon P.
    PLOS ONE, 2019, 14 (06):
  • [44] Assessment of cognitive function in older patients in the emergency department.
    Wong, N.
    Hwang, U.
    JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2007, 55 (04) : S123 - S123
  • [45] Six-Month Impairment in Cognition, Mental Health, and Physical Function Following COVID-19-Associated Respiratory Failure
    Maley, Jason H.
    Sandsmark, Danielle K.
    Trainor, Alison
    Bass, Geoffrey D.
    Dabrowski, Cian L.
    Magdamo, Brigid A.
    Durkin, Bridget
    Hayes, Margaret M.
    Schwartzstein, Richard M.
    Stevens, Jennifer P.
    Kaplan, Lewis J.
    Mikkelsen, Mark E.
    Lane-Fall, Meghan B.
    CRITICAL CARE EXPLORATIONS, 2022, 4 (04)
  • [46] CHANGES IN FUNCTIONAL STATUS DURING A SIX-MONTH PERIOD IN OLDER NEWLY-DIAGNOSED CANCER PATIENTS
    Puts, M. T.
    Monette, J.
    Girre, V.
    Wolfson, C.
    Monette, M.
    Batist, G.
    Bergman, H.
    GERONTOLOGIST, 2010, 50 : 414 - 414
  • [47] Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method
    Han, Jin H.
    Wilson, Amanda
    Vasilevskis, Eduard E.
    Shintani, Ayumi
    Schnelle, John F.
    Dittus, Robert S.
    Graves, Amy J.
    Storrow, Alan B.
    Shuster, John
    Ely, E. Wesley
    ANNALS OF EMERGENCY MEDICINE, 2013, 62 (05) : 457 - 465
  • [48] Knowledge, Skills, and Attitudes of Clinicians Towards the Assessment of Cognition in Older Patients in the Emergency Department
    Kennelly, Sean
    Morley, Deirdre
    Rochford, Martin
    O' Neill, Desmond
    IRISH JOURNAL OF MEDICAL SCIENCE, 2012, 181 : S231 - S232
  • [49] Knowledge, skills and attitudes of doctors towards assessing cognition in older patients in the emergency department
    Kennelly, Sean P.
    Morley, Deirdre
    Coughlan, Tara
    Collins, Ronan
    Rochford, Martin
    O'Neill, Desmond
    POSTGRADUATE MEDICAL JOURNAL, 2013, 89 (1049) : 137 - 141
  • [50] The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients
    Han, Jin H.
    Vasilevskis, Eduard E.
    Schnelle, John F.
    Shintani, Ayumi
    Dittus, Robert S.
    Wilson, Amanda
    Ely, E. Wesley
    ACADEMIC EMERGENCY MEDICINE, 2015, 22 (07) : 878 - 882