Persistent Link:
http://hdl.handle.net/10150/194458
Title:
Allostatic Load and Delirium among Hospitalized Elders
Author:
Rigney, Jr., Theodore Smith
Issue Date:
2009
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Delirium is a state of acute confusion and is common in hospitalized older adults. Delirium is associated with significant increases in morbidity and mortality, as well as healthcare costs. Delirium also is associated with functional and cognitive decline, as well as need for institutionalization and rehabilitation. Delirium can cause psychosocial distress for patients and families. While much is understood about the epidemiology of delirium, the pathophysiological mechanisms that lead to the development of delirium are less clearly defined.The purpose of this study was to investigate the relationship of allostatic load (AL), a composite measure of primary (i.e. acute) stress mediators and secondary (i.e. chronic) stress outcomes and delirium in the hospitalized older adult. Development of the Allostatic Load & Delirium in Hospitalized Elderly model provided a theoretical framework for the study.Forty- four participants, ranging from 66 to 93 years of age (M = 76 years of age) were recruited from three intensive care units and enrolled once they were determined not to have a cognitive deficit or prevalent delirium, as assessed by the Standardized Mini-Mental State Examination and Confusion Assessment Method (CAM), respectively. Ten AL components reflective of acute and chronic stress were collected upon admission. Allostatic load was calculated as the sum of the number of components for which the participant was rated in the highest risk quartile. Allostatic load subsets based on acute and chronic components were also calculated. Incident delirium was assessed 48 -72 hours after admission with the CAM.Findings indicated that the incidence of delirium was 29.2%. The subset AL score based on components considered primary stress mediators was significantly related to delirium; however, no other variables were associated with delirium. Logistic regression modeling indicated that an AL subset of primary stress mediators did predict the incidence of delirium (OR 2.5, 95% CI = 1.12, 5.79; X2 (1) = 5.668, p < .05).The findings from this study exploring the relationship between AL and delirium in the hospitalized older adult suggest that an AL score based on primary mediators may be useful in predicting delirium in the hospitalized older adult.
Type:
text; Electronic Dissertation
Keywords:
allostasis; allostatic load; delirium; elderly; hospital
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Nursing; Graduate College
Degree Grantor:
University of Arizona
Committee Chair:
Insel, Kathleen C.

Full metadata record

DC FieldValue Language
dc.language.isoENen_US
dc.titleAllostatic Load and Delirium among Hospitalized Eldersen_US
dc.creatorRigney, Jr., Theodore Smithen_US
dc.contributor.authorRigney, Jr., Theodore Smithen_US
dc.date.issued2009en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractDelirium is a state of acute confusion and is common in hospitalized older adults. Delirium is associated with significant increases in morbidity and mortality, as well as healthcare costs. Delirium also is associated with functional and cognitive decline, as well as need for institutionalization and rehabilitation. Delirium can cause psychosocial distress for patients and families. While much is understood about the epidemiology of delirium, the pathophysiological mechanisms that lead to the development of delirium are less clearly defined.The purpose of this study was to investigate the relationship of allostatic load (AL), a composite measure of primary (i.e. acute) stress mediators and secondary (i.e. chronic) stress outcomes and delirium in the hospitalized older adult. Development of the Allostatic Load & Delirium in Hospitalized Elderly model provided a theoretical framework for the study.Forty- four participants, ranging from 66 to 93 years of age (M = 76 years of age) were recruited from three intensive care units and enrolled once they were determined not to have a cognitive deficit or prevalent delirium, as assessed by the Standardized Mini-Mental State Examination and Confusion Assessment Method (CAM), respectively. Ten AL components reflective of acute and chronic stress were collected upon admission. Allostatic load was calculated as the sum of the number of components for which the participant was rated in the highest risk quartile. Allostatic load subsets based on acute and chronic components were also calculated. Incident delirium was assessed 48 -72 hours after admission with the CAM.Findings indicated that the incidence of delirium was 29.2%. The subset AL score based on components considered primary stress mediators was significantly related to delirium; however, no other variables were associated with delirium. Logistic regression modeling indicated that an AL subset of primary stress mediators did predict the incidence of delirium (OR 2.5, 95% CI = 1.12, 5.79; X2 (1) = 5.668, p < .05).The findings from this study exploring the relationship between AL and delirium in the hospitalized older adult suggest that an AL score based on primary mediators may be useful in predicting delirium in the hospitalized older adult.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectallostasisen_US
dc.subjectallostatic loaden_US
dc.subjectdeliriumen_US
dc.subjectelderlyen_US
dc.subjecthospitalen_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineNursingen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.chairInsel, Kathleen C.en_US
dc.contributor.committeememberMurdaugh, Carolynen_US
dc.contributor.committeememberRitter, Leslieen_US
dc.identifier.proquest10355en_US
dc.identifier.oclc659752120en_US
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