急性老年病房中痴呆和谵妄的检测与记录

Detection and documentation of dementia and delirium in acute geriatric wards.

作者信息

Laurila Jouko V, Pitkala Kaisu H, Strandberg Timo E, Tilvis Reijo S

机构信息

Department of Medicine, Helsinki University Hospital, Geriatric Clinic, Helsinki, Finland.

出版信息

Gen Hosp Psychiatry. 2004 Jan-Feb;26(1):31-5. doi: 10.1016/j.genhosppsych.2003.08.003.

DOI:10.1016/j.genhosppsych.2003.08.003

PMID:14757300

Abstract

Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders.

摘要

研究表明，对住院老年患者认知障碍的检测存在不足。在芬兰赫尔辛基的两家老年医院进行了一项现况研究，对219名70岁以上的急性病患者进行评估，以检测痴呆和谵妄。将病历中痴呆和谵妄的记录以及护士记录中的意识模糊症状与研究人员在详细评估认知状态后做出的诊断进行比较。88例患者中有70例（79.5%）的病历中提到了认知能力下降。42例（47.7%）痴呆患者接受了认知测试，其中47例（53.4%）记录了痴呆诊断。仅4例（4.5%）记录了具体的病因诊断。88例患者中有80例（90.9%）至少在这四种方式中的一种存在认知障碍（敏感性为0.93）。8例患者被误诊为痴呆（特异性为0.94）。研究人员诊断出77例（35.2%）患者患有谵妄，但病历中仅记录了31例（40.3%）。77例患者中有64例（83.1%）在护士记录中有意识模糊的迹象。检测和记录不足可能导致这两种疾病的治疗不足。