Ingreso hospitalario y aparición de delirio en adultos mayores con fragilidad física: estudio transversal

Rodrigues, João Alberto Martins; Lenardt, Maria Helena; Cechinel, Clovis; Cruz, Elaine Drehmer de Almeida; Tsunoda, Audrey Tieko; Kuznier, Tatiane Prette

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0156en copiar

Ingreso hospitalario y aparición de delirio en adultos mayores con fragilidad física: estudio transversal

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo

Analizar la relación entre la hospitalización y la aparición de delirio en adultos mayores con fragilidad física.

Método

Estudio transversal realizado en un hospital público del sur de Brasil. Participaron adultos mayores hospitalizados con edad ≥ 60 años. Se recogieron datos sociodemográficos y clínicos, se realizaron pruebas de fenotipo de fragilidad física y se utilizó el Confusion Assessment Method. Se realizaron análisis descriptivos y se estimaron los odds ratio para las variables fragilidad y delirio.

Resultados

De los 320 adultos mayores evaluados, el 21,14% presentó delirio, el 49% fueron identificados como prefrágiles y el 36,2% como frágiles. De los adultos mayores afectados por delirio, el 71,6% fueron clasificados como frágiles y el 28,3% como prefrágiles (p < 0,001). Se observó asociación entre la aparición de delirio y fragilidad (OR 1,22; IC 95% 1,07 a 1,38), edad ≥ 80 años (OR 1,14; IC 95% 1,01 a 1,32), epilepsia (OR 1,38; IC 95% 1,09 a 1,76), demencia (OR 1,58; IC del 95%: 1,37 a 1,82) y antecedentes de accidente cerebrovascular (OR 1,14; IC del 95%: 1,03 a 1,26).

Conclusión

Hubo una alta frecuencia de adultos mayores prefrágiles y frágiles y la aparición de delirio en los frágiles fue significativamente mayor. Se debe prestar especial atención a los adultos mayores frágiles para prevenir la aparición de delirio durante la hospitalización.

DESCRIPTORES
Anciano Frágil; Hospitalización; Delirio; Estudios Transversales

	TOTAL
	n = 320	95%CI^* *95% CI – 95% Confidence Interval; (SD)^† †SD – Standard Deviation; LTCF – Long-Term Care Facility.
Sex
Female	190	59.4% (53.9–64.6)
Male	130	40.6% (35.4–46.1)
Age
60–70	86	26.9% (22.3–32.0)
70–80	103	32.2% (27.3–37.5)
80 or more	131	40.9% (35.7–46.4)
Education
Illiterate	59	18.4% (14.6–23.1)
Literate (did not attend school)	37	11.6% (8.5–15.5)
Incomplete primary school	116	36.2% (31.2–41.7)
Primary school	65	20.3% (16.3–25.1)
Incomplete secondary school	10	3.1% (1.7–5.7)
Secondary school	22	6.9% (4.6–10.2)
Incomplete higher education	2	0.6% (0.2–2.2)
Higher education	9	2.8% (1.5–5.3)
Color
White	226	70.6% (65.4–75.3)
Brown/mixed race	68	21.2% (17.1–26.1)
Black	23	7.2% (4.8–10.6)
Yellow/Asian	3	0.9% (0.3–2.7)
Marital status
Single	17	5.3% (3.3–8.3)
Married	131	40.9% (35.7–46.4)
Divorced	37	11.6% (8.5–15.5)
Widowed	135	42.2% (36.9–47.7)
Residing with
Spouse and/or children	235	73.4% (68.3–78.0)
Parents and/or siblings	9	2.8% (1.5–5.3)
Alone	47	14.7% (11.2–19.0)
LTCF	12	3.8% (2.2–6.4)
Others	17	5.3% (3.3–8.3)
Professional situation
Working	18	5.6% (3.6–8.7)
Retiree	214	66.9% (61.5–71.8)
Pensioner/on benefits Social assistance	65	20.3% (16.3–25.1)
Home worker	11	3.4% (1.9–6.0)
Unemployed	12	3.8% (2.2–6.4)
Older adult income (minimum wage)
No income	17	5.3% (3.3–8.3)
0–1	127	39.7% (34.5–45.1)
1–3	120	37.5% (32.4–42.9)
3–5	27	8.4% (5.9–12.0)
5–10	5	1.6% (0.7–3.6)
More than 10	1	0.3% (0.1–1.7)
Did not inform	23	7.2% (4.8–10.6)
Family income (minimum wage)
No income	1	0.3% (0.1–1.7)
0–1	35	10.9% (8.0–14.8)
1–3	89	27.8% (23.2–33.0)
3–5	75	23.4% (19.1–28.4)
5–10	16	5% (3.1–8.0)
More than 10	3	0.9% (0.3–2.7)
Did not inform	101	31.6% (26.7–36.8)
Companion’s degree of kinship
Spouse and/or children	140	43.8% (38.4–49.2)
Parents and/or siblings	3	0.9% (0.3–2.7)
Alone	117	36.6% (31.5–42.0)
Professional caregiver	7	2.2% (1.1–4.4)
Others	53	16.6% (12.9–21.0)
Type of current hospitalization
Clinical	295	92.2% (88.7–94.7)
Surgical	25	7.8% (5.3–11.3)
Reason for current hospitalization
Pneumonia	57	17.8% (14.0–22.4)
Urinary tract infection	52	16.2% (12.6–20.7)
Stroke	31	9.7% (6.9–13.4)
Others	180	56.2% (50.8–61.6)

Variables	OR^* *OR – Odds Ratio;	95% CredI^† †95% CredI – 95% Credible interval;	Adjusted OR^‡ ‡Adjusted OR – Adjusted Odds Ratio.	95% CredI^† †95% CredI – 95% Credible interval;
Sex
Female	1.00	Ref.	1,00	Ref.
Male	0.98	0.89; 1.08	0.98	0.89; 1.08
Color
White	1.00	Ref.	1,00	Ref.
Non white	0.97	0.88; 1.08	0.97	0.88; 1.07
Age
60–70	1.00	Ref.	1,00	Ref.
70–80	1.01	0.90; 1.13	0.98	0.87; 1.11
80 or over	1.31	1.17; 1.46	1.22	1.08; 1.37
Schooling
Primary	1.00	Ref.	1,00	Ref.
Secondary	0.94	0.81; 1.10	1.03	0.89; 1.19
Higher Education	0.93	0.70; 1.22	0.94	0.72; 1.22
Systemic Arterial Hypertension
No	1.00	Ref.	1,00	Ref.
Yes	0.90	0.81; 0.99	0.95	0.87; 1.05
Diabetes mellitus
No	1.00	Ref.	1.00	Ref.
Yes	0.92	0.83; 1.01	1.01	0.92; 1.10
Chronic obstructive pulmonary disease
No	1.00	Ref.	1.00	Ref.
Yes	0.94	0.83; 1.06	0.95	0.85; 1.06
Chronic kidney disease
No	1.00	Ref.	1.00	Ref.
Yes	0.91	0.78; 1.06	0.92	0.81; 1.06
Epilepsy
No	1.00	Ref.	1.00	Ref.
Yes	1.35	1.06; 1.71	1.35	1.10; 1.66
Congestive heart failure
No	1.00	Ref.	1.00	Ref.
Yes	0.93	0.83; 1.05	0.97	0.87; 1.08
Dementia
No	1.00	Ref.	1.00	Ref.
Yes	1.68	1.52; 1.85	1.63	1.46; 1.81
Previous stroke
No	1.00	Ref.	1.00	Ref.
Yes	1.23	1.10; 1.37	1.14	1.03; 1.26

Variables	OR^* *OR – Odds Ratio;	95%CI^† †95%CI – 95% Confidence Interval;	Adjusted OR^‡ ‡Adjusted OR – Adjusted Odds Ratio;	95%CI^† †95%CI – 95% Confidence Interval;	p Value^§ §p-value – obtained via Wald test.
Intercept			0.12	0.02; 0.54	0.0092
Sodium
Normal	1.00	Ref.	1.00	Ref.
Below normal	0.93	0.83; 1.04	0.92	0.82; 1.03	0.2765
Potassium
Below normal	0.98	0.40; 2.21	0.90	0.33; 2.23	0.8258
Normal	1.00	Ref.	1.00	Ref.
Above normal	1.67	0.61; 4.18	1.69	0.54; 4.86	0.3471
Leukocytes
Below normal	1.06	0.05; 7.49	0.77	0.04; 6.04	0.8248
Normal	1.00	Ref.	1.00	Ref.
Above normal	1.50	0.82; 2.71	0.95	0.46; 1.93	0.8961
PCR
Normal	1.00	Ref.	1.00	Ref.
Above normal	1.17	1.02; 1.33	1.14	1.02; 1.30	0.0495

	TOTAL
	n = 320	95% CI^* *IC 95% CI – 95%Confidence Interval; (SD)^† †SD – Standard Deviation.
Sodium
Normal	205	64.1% (60.3–70.8)
Below normal	97	30.3% (26.2–36.4)
Above normal	10	3.1% (1.8–5.8)
Not collected	8
Acute kidney failure
Yes	90	28.1% (23.8–33.7)
No	226	70.6% (66.3–76.2)
Not collected	4
CRP
Normal	47	14.7% (13.0–21.8)
Above normal	230	71.9% (78.2–87.0)
Not collected	43
Hemoglobin
Normal	82	25.6% (21.6–31.3)
Below normal	228	71.2% (67.7–77.5)
Above normal	3	0.9% (0.3–2.8)
Not collected	7
Potassium
Normal	245	76.6% (73.4–82.5)
Below normal	42	13.1% (10.1–17.6)
Above normal	26	8.1% (5.7–11.9)
Not collected	7
Leukocytes
Normal	198	61.9% (57.6–68.2)
Below normal	5	1.6% (0.7–3.7)
Above normal	111	34.7% (30.3–40.8)
Not collected	6
Polypharmacy
Normal	166	51.9% (46.4–57.3)
Polypharmacy	131	40.9% (35.7–46.4)
Hyper polypharmacy	23	7.2% (4.8–10.6)
Number of medicines for home use
Mean (SD)	4.57 (3.06)
Median [Min, Max]	4.00 [0. 16.0]

	Total
	(n = 320)	(%)
Arterial hypertension	228	71.2%
Diabetes mellitus	110	34.4%
Dementia	67	20.9%
Brain stroke	64	20%
Hypothyroidism	63	19.7%
Dyslipidemia	63	19.7%
Congestive heart failure	59	18.4%
COPD	51	15.9%
Ischemic heart disease	37	11.5%
Depression	35	10.1%
Chronic kidney disease	23	7.2%
Parkinson’s disease	13	4%
Epilepsy	12	3.7%

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E-mail: reeusp@usp.br

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[1] Corresponding author: João Alberto Martins, Rodrigues Rua Coronel Amazonas Marcondes, 448, Cabral80035-230 – Curitiba, PR, Brazil, morgadinho70@hotmail.com