노인 입원환자에서 Delirium Drug Scale과 섬망 발생의 연관성 분석
Association between the Delirium Drug Scale and the Occurrence of Delirium in Hospitalized Older Patients
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Background : Drugs are one of the major causes of delirium in elderly patients. As drug-associated delirium is usually reversible, evaluating the drug burden is clinically important in terms of delirium prevention. The Delirium Drug Scale (DDS) is a quantification tool developed to assess the impact of drugs on delirium in elderly patients. This study aimed to investigate the association between the scores and the occurrence of delirium in Korean elderly hospitalized patients. Methods : We retrospectively reviewed the electronic medical records of patients who were admitted to a tertiary university hospital from January to December 2017, and underwent Comprehensive Geriatric Assessment. Lists of medications taken by the patients at the time of admission were collected and the occurrence of delirium within two days after admission was identified. The DDS score of each patient was calculated based on the collected medication data. The relationship between DDS scores and delirium occurrence was analyzed using logistic regression. Results : A total of 452 patients were included in the study. The mean age of the patients was 82.0 ± 7.2 years. Delirium was detected in 54 patients (11.9%) and 258 patients (57.1%) were exposed to one or more drugs known to be associated with delirium. The unadjusted odds ratio (OR) for the DDS score was 2.02 (95% confidence interval [CI]:1.66; 2.46). In the multivariable analysis, a history of delirium, polypharmacy, infection, dementia, and age were significantly associated with delirium. When the confounding variables were adjusted, DDS scores were associated with the occurrence of delirium with an OR of 2.15 (95% CI: 1.69; 2.73). Conclusion : DDS scores were associated with delirium occurrence among hospitalized older patients in Korea. The DDS can be considered an objective index when providing medication review services as part of a delirium prevention practice.
Abstract
Background : Drugs are one of the major causes of delirium in elderly patients. As drug-associated delirium is usually reversible, evaluating the drug burden is clinically important in terms of delirium prevention. The Delirium Drug Scale (DDS) is a quantification tool developed to assess the impact of drugs on delirium in elderly patients. This study aimed to investigate the association between the scores and the occurrence of delirium in Korean elderly hospitalized patients. Methods : We retrospectively reviewed the electronic medical records of patients who were admitted to a tertiary university hospital from January to December 2017, and underwent Comprehensive Geriatric Assessment. Lists of medications taken by the patients at the time of admission were collected and the occurrence of delirium within two days after admission was identified. The DDS score of each patient was calculated based on the collected medication data. The relationship between DDS scores and delirium occurrence was analyzed using logistic regression. Results : A total of 452 patients were included in the study. The mean age of the patients was 82.0 ± 7.2 years. Delirium was detected in 54 patients (11.9%) and 258 patients (57.1%) were exposed to one or more drugs known to be associated with delirium. The unadjusted odds ratio (OR) for the DDS score was 2.02 (95% confidence interval [CI]:1.66; 2.46). In the multivariable analysis, a history of delirium, polypharmacy, infection, dementia, and age were significantly associated with delirium. When the confounding variables were adjusted, DDS scores were associated with the occurrence of delirium with an OR of 2.15 (95% CI: 1.69; 2.73). Conclusion : DDS scores were associated with delirium occurrence among hospitalized older patients in Korea. The DDS can be considered an objective index when providing medication review services as part of a delirium prevention practice.
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