2.50
Hdl Handle:
http://hdl.handle.net/10755/157339
Type:
Presentation
Title:
ALLOSTATIC LOAD PRIMARY MEDIATORS PREDICT DELIRIUM IN HOSPITALIZED ELDERLY
Abstract:
ALLOSTATIC LOAD PRIMARY MEDIATORS PREDICT DELIRIUM IN HOSPITALIZED ELDERLY
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Rigney, Ted S., PhD, RNP, ACNP-BC, FAANP
P.I. Institution Name:University of Arizona
Title:Associate Clinical Professor & Assistant Director of the Nurse Practitioner Program
Contact Address:1305 North Martin Avenue, Room 309, Tucson, AZ, 85711, USA
PURPOSE: The purpose of this study was to investigate the relationship of Allostatic Load (AL) and the incidence of delirium in the hospitalized older adult.
BACKGROUND: Allostasis is a continuous process of physiological adaptation to potentially stressful challenges or in anticipation of stressful challenges. Allostasis describes wide variability in the physiological parameters of several regulatory systems as an integrated response that indicates a healthy functioning system, able to anticipate and respond effectively to stress. However, these regulatory systems are vulnerable to overload and dysfunction, particularly when there are unpredictable, exaggerated, repetitive or chronic exposures to stress. This state of dysfunction is described as AL and reflects the cumulative negative effects of adaptation to immediate and past environmental stressors and psychosocial challenges. The cascade of pathophysiological events that lead from allostasis to AL begins as primary mediators, such as catecholamines and cortisol, cause primary effects that lead to the development of secondary outcomes. The effects of secondary outcomes then lead to tertiary outcomes, or actual disease.
METHODS: English-speaking participants equal to or greater than 65 years of age admitted to the intensive care unit were included. Participants were excluded if they had severe cognitive dysfunction, defined as a Standardized Mini-Mental Status Exam (SMMSE) score of 23 or less and/or had prevalent delirium, defined as a positive finding on the Confusion Assessment Method (CAM). Ten components reflective of primary effects and secondary outcomes were collected on admission to the hospital. For each of the 10 components participants were classified into quartiles based on the distribution of scores in the sample. Allostatic load was calculated as the sum of the number of components for which the participant was rated in the highest risk quartile. Separate scores were also derived for components of primary effects and secondary outcomes. Incident delirium was assessed 48 to 72 hours after admission using the CAM.
RESULTS: Mean age was 75.7 with a range of 66 to 93 years. Fifty-seven percent were men. Mean SMMSE score was 28.8 with a range of 25 to 30. The incidence of delirium was 29%. The AL score derived from the composite measure of primary effects - urinary cortisol, epinephrine and norepinephrine and serum dehydroepiandrosterone sulfate, predicted the incidence of delirium. For every point increase in the primary effects score the odds of developing delirium increased by 2.54. The AL score, the secondary outcomes score and individual AL components were not related significantly to the incidence of delirium. IMPLICATIONS: These findings suggest an AL score derived from a composite measure of primary effects may be useful in predicting delirium in the hospitalized older adult. Delirium leads to a number of poor outcomes and questions remain unanswered regarding the pathophysiology of delirium. The theory of AL considers the cumulative physiological dysfunction that can occur because of exposure to psychosocial and environmental stress. The idea that such stress may cause a differential risk for delirium in the hospitalized older adult may suggest additional avenues of research, ultimately leading to improved prevention of delirium in this vulnerable population.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleALLOSTATIC LOAD PRIMARY MEDIATORS PREDICT DELIRIUM IN HOSPITALIZED ELDERLYen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157339-
dc.description.abstract<table><tr><td colspan="2" class="item-title">ALLOSTATIC LOAD PRIMARY MEDIATORS PREDICT DELIRIUM IN HOSPITALIZED ELDERLY</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Rigney, Ted S., PhD, RNP, ACNP-BC, FAANP</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Arizona</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Clinical Professor &amp; Assistant Director of the Nurse Practitioner Program</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1305 North Martin Avenue, Room 309, Tucson, AZ, 85711, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">trigney@nursing.arizona.edu</td></tr><tr><td colspan="2" class="item-abstract">PURPOSE: The purpose of this study was to investigate the relationship of Allostatic Load (AL) and the incidence of delirium in the hospitalized older adult. <br/>BACKGROUND: Allostasis is a continuous process of physiological adaptation to potentially stressful challenges or in anticipation of stressful challenges. Allostasis describes wide variability in the physiological parameters of several regulatory systems as an integrated response that indicates a healthy functioning system, able to anticipate and respond effectively to stress. However, these regulatory systems are vulnerable to overload and dysfunction, particularly when there are unpredictable, exaggerated, repetitive or chronic exposures to stress. This state of dysfunction is described as AL and reflects the cumulative negative effects of adaptation to immediate and past environmental stressors and psychosocial challenges. The cascade of pathophysiological events that lead from allostasis to AL begins as primary mediators, such as catecholamines and cortisol, cause primary effects that lead to the development of secondary outcomes. The effects of secondary outcomes then lead to tertiary outcomes, or actual disease. <br/>METHODS: English-speaking participants equal to or greater than 65 years of age admitted to the intensive care unit were included. Participants were excluded if they had severe cognitive dysfunction, defined as a Standardized Mini-Mental Status Exam (SMMSE) score of 23 or less and/or had prevalent delirium, defined as a positive finding on the Confusion Assessment Method (CAM). Ten components reflective of primary effects and secondary outcomes were collected on admission to the hospital. For each of the 10 components participants were classified into quartiles based on the distribution of scores in the sample. Allostatic load was calculated as the sum of the number of components for which the participant was rated in the highest risk quartile. Separate scores were also derived for components of primary effects and secondary outcomes. Incident delirium was assessed 48 to 72 hours after admission using the CAM. <br/>RESULTS: Mean age was 75.7 with a range of 66 to 93 years. Fifty-seven percent were men. Mean SMMSE score was 28.8 with a range of 25 to 30. The incidence of delirium was 29%. The AL score derived from the composite measure of primary effects - urinary cortisol, epinephrine and norepinephrine and serum dehydroepiandrosterone sulfate, predicted the incidence of delirium. For every point increase in the primary effects score the odds of developing delirium increased by 2.54. The AL score, the secondary outcomes score and individual AL components were not related significantly to the incidence of delirium. IMPLICATIONS: These findings suggest an AL score derived from a composite measure of primary effects may be useful in predicting delirium in the hospitalized older adult. Delirium leads to a number of poor outcomes and questions remain unanswered regarding the pathophysiology of delirium. The theory of AL considers the cumulative physiological dysfunction that can occur because of exposure to psychosocial and environmental stress. The idea that such stress may cause a differential risk for delirium in the hospitalized older adult may suggest additional avenues of research, ultimately leading to improved prevention of delirium in this vulnerable population. <br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:46:58Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:46:58Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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