Dovjak Peter, Iglseder Bernhard, Mikosch Peter, Gosch Markus, Müller Ernst, Pinter Georg, Pils Katharina, Gerstofer Inge, Thaler Heinrich, Zmaritz Michaela, Weissenberger-Leduc Monique, Müller Walter
Department of Acute Geriatrics, Hospital of Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Austria,
Wien Med Wochenschr. 2013 Oct;163(19-20):448-54. doi: 10.1007/s10354-013-0228-y. Epub 2013 Aug 15.
The course of older patients with hip fractures is often complicated by infections and delirium. Accurate care and high suspicion for these complications are essential, since these conditions are associated with an increase in mortality, length of hospital stay and nursing home placement, poorer mobility, and functional decline. Because of immunosenescence and higher infection rates, older patients need specific care, immediate diagnosis, and treatment of infections. Numerous guidelines of various medical societies outline the management of nosocomial infections, but there is a need of an individualized treatment plan because of comorbidities and polypharmacy. Hygiene measures have first priority to reduce the rate of infections. Treatment of geriatric syndromes like malnutrition, exsiccosis, gait disorders, falls, delirium, urine incontinence, and organ insufficiency are as important as immunization against pneumococci and influenza. Advanced age, cognitive impairment, hearing loss, peripheral vascular disease, prior delirium episodes, sight disorders, and polypharmacy are established risk factors for delirium; thus, older people with several chronic diseases are prone to delirium. A multifactorial approach, comprising standardized screening, oxygen support, intravenous fluid administration and augmented nutrition, monitoring of vital signs, pain treatment, optimized medication, and modification in perioperative management, significantly reduces delirium incidence during hospitalization for hip fracture. An interdisciplinary approach between surgeons and geriatricians may warrant optimized satisfaction of patients' needs.
老年髋部骨折患者的病程常因感染和谵妄而复杂化。对这些并发症进行准确的护理并保持高度怀疑至关重要，因为这些情况与死亡率增加、住院时间延长、入住养老院、行动能力较差以及功能衰退有关。由于免疫衰老和感染率较高，老年患者需要特殊护理、感染的即时诊断和治疗。各种医学协会的众多指南概述了医院感染的管理，但由于合并症和多种药物治疗的情况，需要个性化的治疗方案。卫生措施对于降低感染率具有首要优先级。治疗老年综合征，如营养不良、脱水、步态障碍、跌倒、谵妄、尿失禁和器官功能不全，与接种肺炎球菌疫苗和流感疫苗同样重要。高龄、认知障碍、听力丧失、外周血管疾病、既往谵妄发作、视力障碍和多种药物治疗是已确定的谵妄危险因素；因此，患有多种慢性病的老年人易发生谵妄。一种多因素方法，包括标准化筛查、氧气支持、静脉输液和强化营养、生命体征监测、疼痛治疗、优化用药以及围手术期管理的调整，可显著降低髋部骨折住院期间的谵妄发生率。外科医生和老年病医生之间的跨学科方法可能保证患者需求得到最佳满足。
