住院老年患者谵妄的全球发病率和流行率及其风险因素：系统回顾与荟萃分析

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-11-15 DOI:10.1016/j.ijnurstu.2024.104959

Chia-Rung Wu , Kai-Mei Chang , Victoria Tranyor , Hsiao-Yean Chiu

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引用次数: 0

摘要

背景谵妄是老年内科病人中常见的并发症，可导致不良后果。目的本研究系统地调查了谵妄的发生率、流行率和风险因素，以改善对住院老年内科病人的识别、预防和管理。方法本研究方案于 2024 年 4 月 29 日在 PROSPERO 注册（注册号：CRD42024536624）。我们在 PubMed、Embase 和 ProQuest 数据库中检索了自数据库建立至 2024 年 9 月 25 日期间发表的相关文章。我们纳入了报告住院老年患者谵妄患病率、发病率和风险因素的观察性研究。两名独立审稿人提取了数据。结果共有 35 项研究（12,097 名参与者）符合纳入标准，汇总结果显示住院老年患者中谵妄的患病率为 23.6%（95% 置信区间 = 19% 到 29%），谵妄的发病率为 13.5%（n = 32，95% 置信区间 = 11% 到 17%）。研究质量和国家分别是解释谵妄发生率和发病率异质性的重要调节因素（P均为0.001）。谵妄的风险因素包括虚弱（几率比 = 2.05）、身体约束（5.01）、跌倒（1.99）、重病（1.32）（使用急性生理学和慢性健康评估 II 进行评估）和认知障碍（2.61）。年龄越大，谵妄风险越高，而教育程度越高，谵妄风险越低（B = 1.69 和 0.92）。本研究提供的见解可帮助医疗服务提供者应用快速有效的评估工具，从而为实施预防谵妄的干预措施提供支持。注册该研究方案已在 PROSPERO 上进行了前瞻性注册（注册号：CRD42024536624）。

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Global incidence and prevalence of delirium and its risk factors in medically hospitalized older patients: A systematic review and meta-analysis

Background

Delirium is a common complication among older medical patients that can lead to undesirable outcomes.

Objectives

This study systematically investigated the incidence, prevalence, and risk factors of delirium to improve its recognition, prevention, and management in medically hospitalized older patients.

Methods

The study protocol was registered at PROSPERO on April 29, 2024 (registration number: CRD42024536624). We searched the PubMed, Embase, and ProQuest databases for relevant articles published between database inception and September 25, 2024. We included observational studies reporting the prevalence, incidence, and risk factors of delirium among medically hospitalized older patients. Two independent reviewers extracted the data. A random-effects model was used for data analysis.

Results

A total of 35 studies encompassing 12,097 participants met the inclusion criteria, yielding a 23.6 % pooled prevalence of delirium (95 % confidence interval = 19 % to 29 %) and a 13.5 % pooled incidence of delirium (n = 32, 95 % confidence interval = 11 % to 17 %) among medically hospitalized older patients. Study quality and country were significant moderators for explaining the heterogeneity observed in the prevalence and incidence of delirium, respectively (both P < 0.001). The risk factors of delirium included frailty (odds ratio = 2.05), physical restraints (5.01), prior falls (1.99), severe illness (1.32) (evaluated using the Acute Physiology and Chronic Health Evaluation II), and cognitive impairment (2.61). Older age increased delirium risk, whereas years of education mitigated it (B = 1.69 and 0.92, respectively).

Conclusion

Our findings considerably enhance the understanding of the prevalence of delirium and its influencing factors in medically hospitalized older patients. The insights this study provides can enable health-care providers to apply quick and effective assessment tools and can thereby support the implementation of interventions to prevent delirium.

Registration

The study protocol has been prospectively registered on PROSPERO (registration no. CRD42024536624).

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).