Delirium in elderly people.
Delirium in elderly people.
复制标题
DOI：
10.1016/s0140-6736(13)60688-1
复制
发表时间：
2014-03-08
期刊：
影响因子：
168.9
通讯作者：
Saczynski, Jane S.
中科院分区：
文献类型：
--
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
谵妄是一种急性注意力和认知障碍，是老年人常见的、严重的、昂贵的、未被认识到的、往往是致命的疾病。它的诊断需要正式的认知评估和急性发作的症状史。鉴于其典型的复杂的多因素病因，多组分非药物危险因素的方法已被证明是最有效的预防策略。迄今为止，没有令人信服的证据表明药物预防或治疗是有效的。建议减少镇静和镇痛的药物，并结合非药物方法。谵妄可能提供了一个窗口，以阐明脑病理生理学，作为一个标志，脑脆弱性与储备减少和永久性认知损伤的潜在机制。作为一个有效的患者安全指标，谵妄为全系统流程改进提供了目标。公共卫生的优先事项将包括改进编码和报销，改善研究资金，以及对临床医生和公众进行有关谵妄重要性的广泛教育。
Delirium, an acute disorder of attention and cognition, is a common, serious, costly, under-recognized and often fatal condition for seniors. Its diagnosis requires a formal cognitive assessment and history of acute onset of symptoms. Given its typically complex multifactorial etiology, multicomponent nonpharmacologic risk factor approaches have proven to be the most effective strategy for prevention. To date, there is no convincing evidence that pharmacologic prevention or treatment is effective. Drug reduction for sedation and analgesia combined with nonpharmacologic approaches are recommended. Delirium may provide a window to elucidate brain pathophysiology, serving both as a marker of brain vulnerability with decreased reserve and a potential mechanism for permanent cognitive damage. As a potent patient safety indicator, delirium provides a target for system-wide process improvements. Public health priorities will include improvements in coding and reimbursement, improved research funding, and widespread education for clinicians and the public about the importance of delirium.