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Delirio en pacientes de edad avanzada y el riesgo de mortalidad posterior al alta, la institucionalización y la

Joost Witlox¹, Lisa S M Eurelings, Jos F M de Jonghe

¹Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands.

|July 29, 2010

Resumen

El delirio en pacientes ancianos aumenta significativamente el riesgo de malos resultados a largo plazo, incluida la muerte, la institucionalización y la demencia, incluso después de tener en cuenta otros factores de salud.

Área de la Ciencia:

Medicina Geriátrica La medicina geriátrica es una especialidad de la medicina geriátrica.
La neurociencia es la neurociencia.
Salud Pública La salud pública.

Sus antecedentes:

El delirio es una complicación frecuente y grave en adultos mayores.
La evidencia existente sugiere un vínculo entre el delirio y los resultados adversos a largo plazo para la salud.
El delirio a menudo afecta a personas con condiciones médicas graves preexistentes, lo que complica la evaluación de los resultados.

Objetivo del estudio:

Evaluar la asociación entre el delirio en personas mayores y los resultados adversos a largo plazo.
Los resultados a largo plazo se definieron como mortalidad, institucionalización o desarrollo de demencia.
El estudio tuvo como objetivo controlar los factores de confusión significativos en esta asociación.

Principales métodos:

Se realizó una búsqueda sistemática de la literatura en las principales bases de datos (MEDLINE, EMBASE, PsycINFO, CINAHL) desde 1981 hasta 2010.
Se incluyeron estudios observacionales de pacientes ancianos con delirio, informando sobre mortalidad, institucionalización o demencia después de al menos 3 meses de seguimiento.
La calidad del estudio se evaluó utilizando los criterios de la lista de verificación STROBE; el metanálisis utilizó modelos de efectos aleatorios para las estimaciones agrupadas.

Principales resultados:

Se dio prioridad a los estudios de alta calidad, controlando la edad, el sexo, la gravedad de la enfermedad y la demencia basal.
El delirio se asoció con un riesgo significativamente mayor de muerte (HR, 1.95), institucionalización (OR, 2.41) y demencia (OR, 12.52).
Los resultados se mantuvieron sólidos en todos los análisis de sensibilidad y secundarios, confirmando la asociación independiente.

Conclusiones:

Este metanálisis confirma que el delirio en los ancianos está asociado de forma independiente con malos resultados a largo plazo.
Estos resultados adversos incluyen una mayor mortalidad, mayores tasas de institucionalización y una mayor probabilidad de desarrollar demencia.
Los hallazgos subrayan la importancia de reconocer y manejar el delirio en las poblaciones mayores para mitigar las consecuencias a largo plazo.

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