Liron Sinvani, Stephanie Izard, Alexandra Perrin, Yan Liu, Codruta Chiuzan, Stefani Slotnick, Rebecca Affoo, Nicole Rogus-Pulia, Alexander Makhnevich
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The objective of this study was to determine whether nil per os (NPO) and dysphagia diets (thickened liquids) are associated with delirium in patients with ADRD and whether dehydration mediates these relationships.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting and participants: </strong>Data were obtained from a large integrated health system in New York (11 hospitals) and included hospitalized older adults (aged ≥65 years) with ADRD admitted between 2017 and 2022 with clinical suspicion of dysphagia.</p><p><strong>Methods: </strong>The main variables were NPO on admission (≥24 vs <24 hours; cohort 1) and prescription of thickened liquids (vs thin liquids; cohort 2). The primary outcome was new delirium developed 48 hours after admission. Multivariable logistic regression was used to determine the association between NPO time and new delirium while adjusting for all prespecified covariates of interest. The relationship between thickened liquids and new delirium was assessed similarly to NPO time.</p><p><strong>Results: </strong>Of 11,933 patients, the average age ± SD was 85.8 ± 7.92 years. In a multivariable model of cohort 1, NPO (odds ratio [OR], 1.398; 95% CI, 1.273-1.536; P < .001) and dehydration (OR, 1.837; 95% CI, 1.678-2.012; P < .001) were associated with higher odds of new delirium. In a multivariable model of cohort 2, thickened liquids were associated with decreased odds of new delirium (OR 0.867; 95% CI: 0.796, 0.945; P = .001), whereas NPO (OR, 1.480; 95% CI, 1.340-1.634; P < .001) and dehydration (OR, 1.804; 95% CI, 1.634-1.991; P < .001) were associated with increased odds of new delirium. Dehydration did not mediate the relationship between restriction and new delirium.</p><p><strong>Conclusions and implications: </strong>Limiting NPO and preventing dehydration could lower delirium risk and improve outcomes for patients with ADRD. 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The relationship between thickened liquids and new delirium was assessed similarly to NPO time.</p><p><strong>Results: </strong>Of 11,933 patients, the average age ± SD was 85.8 ± 7.92 years. In a multivariable model of cohort 1, NPO (odds ratio [OR], 1.398; 95% CI, 1.273-1.536; P < .001) and dehydration (OR, 1.837; 95% CI, 1.678-2.012; P < .001) were associated with higher odds of new delirium. In a multivariable model of cohort 2, thickened liquids were associated with decreased odds of new delirium (OR 0.867; 95% CI: 0.796, 0.945; P = .001), whereas NPO (OR, 1.480; 95% CI, 1.340-1.634; P < .001) and dehydration (OR, 1.804; 95% CI, 1.634-1.991; P < .001) were associated with increased odds of new delirium. Dehydration did not mediate the relationship between restriction and new delirium.</p><p><strong>Conclusions and implications: </strong>Limiting NPO and preventing dehydration could lower delirium risk and improve outcomes for patients with ADRD. 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引用次数: 0
摘要
目的：阿尔茨海默病及相关痴呆（ADRD）患者经历口服摄入限制。本研究的目的是确定无糖饮食（NPO）和吞咽困难饮食（增稠液体）是否与ADRD患者的谵妄有关，以及脱水是否介导了这些关系。设计：回顾性队列研究。环境和参与者：数据来自纽约的一个大型综合卫生系统（11家医院），包括2017年至2022年间因临床怀疑吞咽困难而入院的ADRD住院老年人（年龄≥65岁）。方法：主要变量为入院时NPO(≥24)vs结果：11933例患者，平均年龄±SD为85.8±7.92岁。在队列1的多变量模型中，NPO（比值比[OR]， 1.398; 95% CI, 1.273-1.536; P < .001）和脱水（比值比[OR]， 1.837; 95% CI, 1.678-2.012; P < .001）与新发谵妄的较高几率相关。在队列2的多变量模型中，增稠的液体与新发谵妄的几率降低相关（OR 0.867; 95% CI: 0.796, 0.945; P = 0.001），而NPO （OR 1.480; 95% CI, 1.340-1.634; P < 0.001）和脱水（OR 1.804; 95% CI, 1.634-1.991; P < 0.001）与新发谵妄的几率增加相关。脱水不介导限制和新谵妄之间的关系。结论和意义：限制NPO和预防脱水可以降低谵妄风险，改善ADRD患者的预后。需要进一步的研究来证实这些结果。
Nil per os on Admission and Dehydration Are Risk Factors for Delirium in Hospitalized Older Adults With Dementia and Dysphagia.
Objectives: Patients with Alzheimer's disease and related dementias (ADRD) experience oral intake restriction. The objective of this study was to determine whether nil per os (NPO) and dysphagia diets (thickened liquids) are associated with delirium in patients with ADRD and whether dehydration mediates these relationships.
Design: Retrospective cohort study.
Setting and participants: Data were obtained from a large integrated health system in New York (11 hospitals) and included hospitalized older adults (aged ≥65 years) with ADRD admitted between 2017 and 2022 with clinical suspicion of dysphagia.
Methods: The main variables were NPO on admission (≥24 vs <24 hours; cohort 1) and prescription of thickened liquids (vs thin liquids; cohort 2). The primary outcome was new delirium developed 48 hours after admission. Multivariable logistic regression was used to determine the association between NPO time and new delirium while adjusting for all prespecified covariates of interest. The relationship between thickened liquids and new delirium was assessed similarly to NPO time.
Results: Of 11,933 patients, the average age ± SD was 85.8 ± 7.92 years. In a multivariable model of cohort 1, NPO (odds ratio [OR], 1.398; 95% CI, 1.273-1.536; P < .001) and dehydration (OR, 1.837; 95% CI, 1.678-2.012; P < .001) were associated with higher odds of new delirium. In a multivariable model of cohort 2, thickened liquids were associated with decreased odds of new delirium (OR 0.867; 95% CI: 0.796, 0.945; P = .001), whereas NPO (OR, 1.480; 95% CI, 1.340-1.634; P < .001) and dehydration (OR, 1.804; 95% CI, 1.634-1.991; P < .001) were associated with increased odds of new delirium. Dehydration did not mediate the relationship between restriction and new delirium.
Conclusions and implications: Limiting NPO and preventing dehydration could lower delirium risk and improve outcomes for patients with ADRD. Future research is needed to confirm these results.
期刊介绍：
JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates.
The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality
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