New or Worsening Symptoms and Signs in Community-Dwelling Persons with Dementia: Incidence and Relation to Use of Acute Medical Services.
New or Worsening Symptoms and Signs in Community-Dwelling Persons with Dementia: Incidence and Relation to Use of Acute Medical Services.
复制标题
DOI：
10.1111/jgs.14672
复制
发表时间：
2017-04
影响因子：
6.3
通讯作者：
Zimmerman S
中科院分区：
文献类型：
--
作者：
Sloane PD;Schifeling CH;Beeber AS;Ward KT;Reed D;Gwyther LP;Matchar B;Zimmerman S
了解社区居住的阿尔茨海默病及相关痴呆（ADRD）患者的家庭照顾者出现的症状范围。为期六个月的纵向前瞻性研究，以确定新发或恶化症状的发生率及其与急症医疗服务使用的关系。以社区为基础的来自多个州的志愿者样本。136名患有痴呆症严重程度的患者-护理者。老年人和/或痴呆症患者常见的44种症状和体征；急诊科就诊、住院和死亡的频率；以及报告的症状和紧急医疗护理之间的联系。在平均5.7个月的随访期间，新的或恶化的器官特异性症状（90%的参与者）、非特异性症状（89%）和行为症状（88%）很常见，护理人员平均报告了7种新的或恶化的症状。最常见的是神志不清（74%）、活动减少（64%）、躁动（57%）、幻觉/妄想（45%）、声音和语言问题（45%）、不吃不喝（44%）、压力/焦虑（41%）。住院和急诊科分别占19%和20%的参与者，并且与器官特异性症状相关（OR 3.15， P=0.02），与非特异性症状相关较少（OR 2.27， P=0.07），与行为症状相关甚少（OR 1.44， P= 0.38）。在每个症状类别中，某些症状与急性医疗服务使用显著相关。ADRD患者的家庭照顾者必须对各种医学、非特异性和行为症状作出反应。新发症状或加重症状的高发生率以及急性医疗护理的使用表明，需要在护理人员教育中更好地针对症状进行评估和管理。
To understand the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer's disease and related dementias (ADRD). Six-month longitudinal prospective study to identify the incidence of new or worsening symptoms and their association with acute care medical service use. Community-based sample of volunteers from multiple states. 136 patient-caregiver dyads with a range of dementia severity. 44 symptoms and signs common in older persons and/or persons with dementia; frequency of emergency department visits, hospitalizations, and death; and associations between reported symptoms and acute medical care. During a mean of 5.7 months' follow-up, new or worsening organ-specific (90% of participants), nonspecific (89%), and behavioral (88%) symptoms were common, with the average caregiver reporting seven new or worsening symptoms. Most common were worsening confusion (74%), decreased activity (64%), agitation (57%), hallucinations/delusions (45%), voice and speaking problems (45%), not eating or drinking (44%), and stress/anxiety (41%). Hospitalization and emergency department use occurred respectively in 19% and 20% of participants, and were associated with organ-specific symptoms (OR 3.15, P=0.02), less so with nonspecific symptoms (OR 2.27, P=0.07), and very little with behavioral symptoms (OR 1.44, p=0.38). Within each symptom category, certain symptoms were significantly associated with acute medical service use. Family caregivers of persons with ADRD must respond to a variety of medical, nonspecific, and behavioral symptoms. The high incidence of new or worsening symptoms and of acute medical care use suggests a need to better target symptom evaluation and management in caregiver education.