Finkel Sanford I
Schanfield Research Institute, Geriatric Institute, Council for Jewish Elderly, University of Chicago Medical School, Chicago, IL, USA.
Geriatrics. 2003 Jun;58(6):43-4.
There are many reasons why it is important to conduct the cognitive assessment and arrive at a preliminary diagnosis within the primary care setting. In addition to starting the patient on anti-cholinesterase medications, the physician must discuss with the family (and often the patient) issues related to financial matters and self-care. Alzheimer's patients who live alone may be targets for financial and personal exploitation, and are at risk for self-neglect. Community support or provision might be needed to assist with medication compliance, provide nutritional services by shopping for prepared foods or through Meals on Wheels, housekeeping to maintain cleanliness, adult day services to provide social and recreational activities, live-in companions, and assistance with other instrumental activities of daily living. Sometimes more structured or institutional living is necessary. Generally, the primary care practice is not set up to coordinate these additional services, as well as to provide ongoing care. We will discuss potential solutions to providing ongoing care in next month's column.
在基层医疗环境中进行认知评估并得出初步诊断很重要，原因有很多。除了让患者开始服用抗胆碱酯酶药物外，医生还必须与患者家属（通常也包括患者）讨论与财务问题和自我护理相关的事宜。独居的阿尔茨海默病患者可能成为财务和人身剥削的对象，并有自我忽视的风险。可能需要社区支持或服务来协助患者遵医嘱服药，通过购买预制食品或送餐上门提供营养服务，进行家务清洁以保持卫生，提供成人日间服务以开展社交和娱乐活动，安排住家陪伴，以及协助进行其他日常生活工具性活动。有时需要更结构化或机构化的生活安排。一般来说，基层医疗诊所并未设立来协调这些额外服务以及提供持续护理。我们将在下个月的专栏中讨论提供持续护理的潜在解决方案。
