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題 名 | 周全性老年評估個案報告:80歲老年人,急性意識改變=Comprehensive Geriatric Assessment of an 80 Years-old Patient with Acute Conscious Change: A Case Report |
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作 者 | 陳欣湄; 顏啟華; | 書刊名 | 臺灣老年醫學暨老年學雜誌 |
卷 期 | 11:2 2016.05[民105.05] |
頁 次 | 頁127-141 |
分類號 | 415.9518 |
關鍵詞 | 周全性老年評估; 老年譫妄症; 失智症; 憂鬱症; 利尿劑於老年人之使用; Comprehensive geriatric assessment; Delirium in older patient; Dementia; |
語 文 | 中文(Chinese) |
中文摘要 | 本個案為80歲男性,一年前陸續出現意識改變狀況,症狀於最近一個月內嚴重加劇,如用湯匙敲打桌椅、脾氣暴躁、裸體在家中走動、白天睡覺夜晚清醒等。因急性意識障礙,患者住院接受評估治療。我們以周全性老年評估方式,找出其潛在病因、藥物調整、提供支持性治療,急性症狀獲得大幅改善。並針對老年人因多重藥物、多重慢性病、電解質不平衡、傷口感染等原因做探討、治療及提供後續預防方法之衛教。 |
英文摘要 | An 80-years old male had hypertension, diabetes, congestive heart failure, and benign prostatic hyperplasia under regular medicine control. Major depression and dementia were diagnosed in the recent one year because of strange behaviors, such having trouble sleeping, beating furniture with a spoon, wandering naked at home, and sleeping during the day and staying awake at night. With symptoms worsening for a month, he was referred to our geriatric ward for assessment and treatment. Comprehensive geriatric assessment (CGA) showed moderate to severe cognitive disorders (MMSE: 12/30), possible depression (GDS: 10/15), poor daily life function (ADL: 20/100; IADL: 1/8), and highly possible delirium (CAM: 4/4). During his hospitalization, we corrected electrolyte imbalance, treated systemic infection, and eliminated sedative drugs, such as lorazepam. We focused on treating acute conscious change caused by acute delirium. After treatment, his symptoms showed improvement and he started to visit the clinic for regular follow-ups. Delirium as a common clinical syndrome is marked with inattention and acute cognitive dysfunction with its symptom reporting an extensively variable presentation and easily confused with another psychiatric disease, notably dementia or depression. The diverse and multifactorial etiologies of delirium are often the pathophysiological aftermath of an acute disease, medical complication or drug intoxication [15]. As a result, it is often overlooked or underdiagnosed in older adults (those aged over 65 years) due to multiple chronic diseases. Management strategies for delirium focus on prevention and symptom management. Delirium in the elderly can either trigger or contribute to a succession of health problems that may result in functional decline, loss of independence, hospitalization or institutionalization, and even death. It has been shown that delirium is likely to become chronic or bring about permanent sequelae. For conscientious and observant physicians, the most effective way to prevent the emergence of a delirium episode is to take note of the predisposing factors of delirium and eliminate possible precipitating factors. |
本系統中英文摘要資訊取自各篇刊載內容。