ABSTRACT

Objectives

Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood.

Methods

An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Boston. Demographic characteristics, cognition, parental education, health, and participation in cognitively stimulating activities were assessed prior to surgery. Delirium incidence and severity were measured daily during hospitalization.

Results

Higher paternal education was associated with significantly lower incidence of delirium (X²(1, N =547)=8.35, p <.001; odds ratio OR=.93, 95% CI, .87 to .98) and inversely associated with delirium severity (r(545)=−.13, p <.001). Higher maternal education was associated with lower delirium incidence but did not reach statistical significance. The effect of paternal education on delirium incidence was independent of the patient’s education, estimated premorbid intelligence, medical comorbidities, neighborhood disadvantage, and participation in cognitively stimulating activities (X²(2, N =547)=31.22, p <.001).

Conclusions

Examining early-life exposures may yield unique insights into the risks and pathogenesis of delirium.

Clinical Implications

Evaluating long-term factors that increase vulnerability to delirium may improve our ability to calculate risk. It may guide clinical decision-making and inform pre- and post-operative recommendations.

中文翻译：

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老年人手术后的父母教育和谵妄风险

摘要

目标

将老年人术后谵妄的危险因素概念化的努力主要集中在发作前的时间，但人们对早期生活暴露如何影响谵妄风险知之甚少。

方法

波士顿两个学术医疗中心的 547 名 70 岁以上接受重大非心脏手术的患者的观察队列。在手术前评估了人口统计学特征、认知、父母教育、健康和参与认知刺激活动。住院期间每天测量谵妄发生率和严重程度。

结果

较高的父亲教育程度与谵妄发生率显着降低相关（X ² (1, N =547)=8.35, p <.001; OR=.93, 95% CI, .87 to .98）并且与谵妄严重程度 ( r(545) =−.13, p <.001)。较高的母亲教育程度与较低的谵妄发生率相关，但没有达到统计学意义。父亲教育对谵妄发生率的影响独立于患者的教育、估计的病前智力、医学合并症、邻里劣势和参与认知刺激活动 ( X ² (2, N =547)=31.22, p<.001).

结论

检查早期生命暴露可能会对谵妄的风险和发病机制产生独特的见解。

临床意义

评估增加易患谵妄的长期因素可能会提高我们计算风险的能力。它可以指导临床决策并为术前和术后建议提供信息。