高齢患者の妄想症と退院後の死亡率,入院,認知症のリスク:メタ分析
Joost Witlox1, Lisa S M Eurelings, Jos F M de Jonghe
1Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands.
JAMA
|July 29, 2010
まとめ
高齢者の患者における妄想は,他の健康要因を考慮した後でも,死亡,施設収容,認知症を含む長期的な悪い結果のリスクを大幅に増加させます.
科学分野:
- ゲリアトリック・メディシン (老年医学)
- 神経科学は神経科学である.
- 公衆衛生は公衆衛生である.
背景:
- 妄想は,高齢者における頻繁かつ重度の合併症である.
- 現存する証拠は,妄想と長期的な有害な健康結果との関連を示唆している.
- 妄想症は,以前から重篤な病状を有する個人にしばしば影響し,結果の評価を複雑にします.
研究 の 目的:
- 高齢者における妄想と長期的な有害な結果との関連性を評価する.
- 長期的なアウトカムは,死亡率,入院,または認知症の発症として定義されました.
- この研究は,この関連性における重要な混乱要因を制御することを目的とした.
主な方法:
- 1981年から2010年まで,主要なデータベース (MEDLINE,EMBASE,PsycINFO,CINAHL) で体系的な文献検索が行われました.
- 対象となったのは,狂妄症の高齢患者の観察研究であり,死亡率,施設入院,または認知症の報告が少なくとも3ヶ月のフォローアップ後に報告された.
- 研究の質は,STROBEチェックリストの基準を用いて評価され,メタアナリシスでは,ランダム効果モデルを用いて総計評価を行った.
主要な成果:
- 高品質の研究,年齢,性別,疾患の重症度,および初期認知症をコントロールする研究が優先されました.
- 妄想は,死亡リスク (HR,1.95),施設収容 (OR,2.41) および認知症 (OR,12.52) の有意な増加と関連していました.
- 結果は,感度および二次分析において堅調であり続け,独立した関連性を確認しました.
結論:
- このメタアナリシスは,高齢者の妄想が,長期的に悪い結果と独立して関連していることを確認しています.
- これらの有害なアウトカムには,死亡率の上昇,施設収容率の上昇,認知症を発症する可能性の増大が含まれます.
- この発見は,高齢者集団における妄想の認識と管理が,長期的な影響を軽減するための重要性を強調しています.
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