Factors Related to ICU Elderly Patients with Pre-Existing Dementia Develop Delirium

• Main Authors: CHEN,YI-SHAN, 陳依珊
• Other Authors: WANG,JENG
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/urjpm7

碩士 === 長庚科技大學 === 護理系碩士在職專班 === 106 === Background: Delirium is common seen in patients at the intensive care units, and the risk of developing delirium in patients with dementia before admission is higher than that of patients without dementia at the intensive care units, Patients developing delirium can lead to poor prognosis, whiching including prolonged hospital stay, extended days of use of the respirator, increased medical costs, and even elevated infection and mortality rates. Also, the occurrence of delirium can worsen the level of dementia or involved into development of dementia. Purpose: 1)Compare the differences between the predisposing risk factors and precipitating risk factors of patients with dementia and those without dementia at the intensive care units; 2) Compare the difference of the incidence rate of delirium between patients with dementia prior to the intensive care units and those without dementia;3) Compare the differences of the types of delirium between patients with dementia prior to the intensive care units and those without dementia;4) Compare the difference of the length of stay between patients with dementia prior to the intensive care units and those without dementia;5) Compare the difference of the medical costs between patients with dementia prior to the intensive care units and those without dementia;6) Compare of the difference of the predisposing risk factors and precipitating risk factors between patients developing delirium and those without delirium at intensive care units;7) Explore the related risk factors of delirium in intensive care units. Methods: All the subjects were recruited from adult intensive care wards(including an intenal medicine intensive care unit, a respiratory intensive care unit, a surgical intensive care unit, and a cardiology intensive care unit), with a purposive sampling. The Mini-Mental State Examination was used to screen if the subject is demented, and the Informant Questionnaire on Cognitive Decline in the Elderly(IQCODE) was used to ask the subjects family for identifying those are dementia. Delirium was evaluated twice daily (7 am and 5 pm) with Confusion Assessment Method-ICU for continuous 5 days. Statistical analysis: As the questionnaires were collected, all data was coded and analyzed by the SPSS21.0 statistical software. The descriptive statistics was presented with mean values, standard deviation, percentage, and more. The inferent stastistics such as the independent sample t test, the Chi-squared test, the Fisher,s exact test, and the binary logistic regression were used to examine the difference between two groups(with and without dementia) in the number of days of hospitalization, the number of days of ventilator use, the number of days of catheter use, the number of days of restraint, the number of days of delirium. Results: Totoally, 142 subjects were involved in this study and dividevd into a group of patients with dementia (n=74, 70 of them developing delirium duriung the study), and the other group for patients who were not demented (n=68, 37 of them developing delirium). The incidence rate of delirium among elderly patients at intensive care units was established 75.4%, and the incidence rate for elderly patients superimposed on dementia was 94.6% in this study. The mixed type of delirium was the most seen in both groups(n = 34, 45.9%, vs. n = 19, 27.9%), respectively was the hypoactive type (n = 27, 36.5% vs. n = 13, 19.1%), and the hyperactive type(n = 9, 12.2% vs. n = 5, 7.4%). The length of stay for patients at the intensive care units ranged mostly from 3 to 4 days (n = 32, 43.2% vs. 15, 22.1%). The average medical cost in the demented group with delirium (mean=104,480.24 NT dollars, SD = 101792.211) was significant higher than the cost in the demented group without delirium (mean =78,221.64 NT dollars, SD = 76716.640). Conclusion: Both incidence rates of delirium among elderly patients with or without dementia are very high (75.4%, &94.6%). Old age, stay at nursing homes prior to admission, scores of acute physiology and chronic health evaluation (APACHE Π), and IQCODE scores were significantly associated with the development of delirium, which reflecting to predisposing factors and precipitating factors identified in the literatrue and other research. The health care providers at clinics should have knowledge about and dementia, so that the development of delirium can be prevented at an ealier stage, the length of stay, and the medical cost may be decteased. Finally, the quality of care and patient safety can be improved.