Person: Zhang, Ying
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Zhang
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Ying
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Zhang, Ying
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Publication Premature Death Associated With Delirium at 1-Year Follow-up(American Medical Association (AMA), 2005) Leslie, Douglas L.; Zhang, Ying; Holford, Theodore R.; Bogardus, Sidney T.; Leo-Summers, Linda S.; Inouye, SharonBACKGROUND: While previous studies have demonstrated the increased mortality risk associated with delirium, little is known about the mortality time course. The objective of this study is to estimate the fraction of a year of life lost associated with delirium at 1-year follow-up. METHODS: Hospitalized patients 70 years and older who participated in a previous controlled clinical trial of a delirium prevention intervention at an academic medical center from March 25, 1995, through March 18, 1998, were followed up for 1 year after discharge, and patients who died were identified, along with the date of death. The adjusted number of days survived were estimated using a 2-step regression model approach and compared across patients who developed delirium during hospitalization and those who did not develop delirium. RESULTS: After adjusting for pertinent covariates (age, sex, functional status, and comorbidity), patients with delirium survived 274 days, compared with 321 days for patients without delirium, representing a difference of 13% of a year (hazard ratio, 1.62; P<.001). Results were confirmed with a separate binomial regression analysis. CONCLUSIONS: Patients who experienced delirium during hospitalization had a 62% increased risk of mortality and lost an average of 13% of a year of life compared with patients without delirium. Although delirium is an acute condition, it is associated with multiple long-term sequelae that extend beyond the hospital setting, including premature mortality.Publication Risk Factors for Delirium at Discharge(American Medical Association (AMA), 2007) Inouye, Sharon; Zhang, Ying; Jones, Richard Norman; Kiely, Dan K.; Yang, Frances Margaret; Marcantonio, EdwardPublication Depressive Symptoms and the Risk of Incident Delirium in Older Hospitalized Adults(Wiley-Blackwell, 2007) McAvay, Gail J.; Van Ness, Peter H.; Bogardus, Sidney T.; Zhang, Ying; Leslie, Douglas L.; Leo-Summers, Linda S.; Inouye, SharonOBJECTIVES: To determine whether specific subsets of symptoms from the Geriatric Depression Scale (GDS), assessed at hospital admission, were associated with the incidence of delirium. DESIGN: Secondary analysis of a prospective cohort study of patients from the Delirium Prevention Trial. SETTING: General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998. PARTICIPANTS: Four hundred sixteen patients aged 70 and older who were at intermediate or high risk for delirium and were not taking antidepressants at hospital admission. MEASUREMENTS: Depressive symptoms were assessed GDS, and daily assessments of delirium were obtained using the Confusion Assessment Method. RESULTS: Of the 416 patients in the analysis sample, 36 (8.6%) developed delirium within the first 5 days of hospitalization. Patients who developed delirium reported 5.7 depressive symptoms on average, whereas patients without delirium reported an average of 4.2 symptoms. Using a Cox proportional hazards model, it was found that depressive symptoms assessing dysphoric mood and hopelessness were predictive of incident delirium, controlling for measures of physical and mental health. In contrast, symptoms of withdrawal, apathy, and vigor were not significantly associated with delirium. CONCLUSION: These findings suggest that assessing symptoms of dysphoric mood and hopelessness could help identify patients at risk for incident delirium. Future studies should evaluate whether nonpharmacological treatment for these symptoms reduces the risk of delirium.Publication One-Year Health Care Costs Associated With Delirium in the Elderly Population(American Medical Association (AMA), 2008) Leslie, Douglas L.; Marcantonio, Edward; Zhang, Ying; Leo-Summers, Linda; Inouye, SharonPublication Risk Factors for Hospitalization Among Community-Dwelling Primary Care Older Patients(Ovid Technologies (Wolters Kluwer Health), 2008) Inouye, Sharon; Zhang, Ying; Jones, Richard Norman; Shi, Peilin; Cupples, L Adrienne; Calderon, Harold N.; Marcantonio, EdwardBackground: Unplanned hospitalization often represents a costly and hazardous event for the older population. Objectives: To develop and validate a predictive model for unplanned medical hospitalization from administrative data. Research Design: Model development and validation. Subjects: A total of 3919 patients aged >=70 years who were followed for at least 1 year in primary care clinics of an academic medical center. Measures: Risk factor data and the primary outcome of unplanned medical hospitalization were obtained from administrative data. Results: Of 1932 patients in the development cohort, 299 (15%) were hospitalized during 1 year follow up. Five independent risk factors were identified in the preceding year: Deyo-Charlson comorbidity score >=2 [adjusted relative risk (RR) = 1.8; 95% confidence interval (CI): 1.4–2.2], any prior hospitalization (RR = 1.8; 95% CI: 1.5–2.3), 6 or more primary care visits (RR = 1.6; 95% CI: 1.3–2.0), age >=85 years (RR = 1.4; 95% CI: 1.1–1.7), and unmarried status (RR = 1.4; 95% CI: 1.1–1.7). A risk stratification system was created by adding 1 point for each factor present. Rates of hospitalization for the low- (0 factor), intermediate- (1–2 factors), and high-risk (>=3 factors) groups were 5%, 15%, and 34% (P < 0.0001). The corresponding rates in the validation cohort, where 328/1987 (17%) were hospitalized, were 6%, 16%, and 36% (P < 0.0001). Conclusions: A predictive model based on administrative data has been successfully validated for prediction of unplanned hospitalization. This model will identify patients at high risk for hospitalization who may be candidates for preventive interventions.