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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要 65 岁及以上的成年人每年急诊科 (ED) 就诊人数约为 2300 万人次 (18%)。伴随着许多可改变和不可改变的危险因素，认知发生剧烈的、波动性的变化是普遍存在的然而，目前 ED 谵妄的发生率和时间进程在 ED 中高达 35%。预防是唯一有效的治疗方法，但住院老年人中只有 40% 发生谵妄病例。可以预防事件发生，对有谵妄风险的患者进行预测和早期识别——例如在急诊科 – 不幸的是，急诊科提供者未能识别高达 83% 的谵妄病例，这可能会导致重大后果。下游后果，例如急诊室复诊、跌倒和住院治疗，因此，迫切需要采取措施。识别急诊室中谵妄风险最高的老年人，以促进早期干预。该提案的总体目标是确定谵妄的发生率、时间进程和危险因素在急诊室住院期间，这是实施有效预防谵妄的关键先决条件我们将通过以下三个目标来实现这一目标： (1) 确定使用经过验证的检测工具来识别 ED 谵妄的发生率和时间进程，(2) 识别可修改和不可修改的 ED 谵妄事件的风险因素，以及 (3) 检查现有的事件风险分层筛查工具我们建议对 1 级认可的老年急诊科中 65 岁以上的老年人进行一项前瞻性队列研究。我们将收集 ED 入院时所有 ≥ 65 岁患者的谵妄和其他认知障碍筛查结果建立基线认知状态在急诊室住院期间，将定期对患者进行谵妄筛查。确定 ED 谵妄的发生率和时程对于入院的患者，谵妄将持续存在。在住院期间，我们将使用电子健康记录数据对每个护理轮班进行一次评估。在急诊室以及入院后 24 小时和 48 小时内检查可改变和不可改变的谵妄危险因素。此外，我们将评估推荐的老年风险分层工具是否可以预测 ED 谵妄事件。与“国家老龄化研究所：2020-2025 年研究战略方向”的目标一致，该提案的研究结果将提高我们对大脑老化及其对预防的影响的理解，具体来说，这项工作将对老年 ED 护理产生积极影响。通过识别有谵妄风险的老年人子集，我们还将确定谵妄的发生率和危险因素。事件 ED 谵妄，这将是获奖期间预防策略的第一步。将获得衰老研究的特定技能，并从跨学科指导中受益这项研究将通过提供以下内容作为 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。