Chronic disease self-management support for persons with dementia, in a clinical setting.
Chronic disease self-management support for persons with dementia, in a clinical setting.
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在临床环境中，对患有痴呆症患者的慢性疾病自我管理支持。
DOI：
10.2147/jmdh.s121626
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发表时间：
2017
影响因子：
3.3
通讯作者：
Winbolt M
中科院分区：
文献类型：
--
作者：
Ibrahim JE;Anderson LJ;MacPhail A;Lovell JJ;Davis MC;Winbolt M
慢性疾病的负担在痴呆症患者中更大，这是一个随着人口老龄化而不断增长的患者群体。慢性病最佳管理的基石需要有效的患者自我管理。然而，这对于患有痴呆症的老年人来说尤其具有挑战性。痴呆症对一个人自我管理他/她的慢性疾病（例如，糖尿病或心力衰竭）的能力的影响根据受影响的认知领域，损伤的严重程度和自我护理任务的复杂性而有所不同。本文提出了一个框架，描述了认知领域（注意力和信息处理、语言、视觉空间能力和实践、学习和记忆以及执行功能）的障碍如何影响慢性病自我管理的五个关键过程。认识到慢性病患者中存在痴呆症可能会导致更好的结果。痴呆症患者需要个性化的策略，以适应和调整受损的个人和认知领域，以优化他们的自我管理能力。管理策略的临床医生，以对付不良的自我管理，由于差异受损的认知领域也详细介绍了框架。临床医生应与患者和护理人员合作，评估患者目前的能力，确定成功自我管理的潜在障碍，并根据患者的技能调整信息的提供。与年龄有关的慢性病的患病率沿着增加，而非正式护理人员的可用性下降，这就要求制定创新方案，以支持初级保健水平的自我管理。
The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person’s ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure) varies according to the cognitive domain(s) affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function) impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient’s current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient’s skill set. The increasing prevalence of age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level.