一般医院痴呆患者的行为和心理症状、护理人员的痛苦和护理中的并发症：一般医院研究的结果。
Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study.
机构信息
Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar,Technical University of Munich,Germany.
Faculty of Social Work,Mannheim University of Applied Sciences,Mannheim,Germany.
出版信息
Epidemiol Psychiatr Sci. 2018 Jun;27(3):278-287. doi: 10.1017/S2045796016001098. Epub 2017 Jan 9.
AIMS
Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care.
METHODS
Cross-sectional representative study with 1469 patients aged ≥65, including 270 patients with dementia, of 33 randomly selected general hospitals in Germany. BPSD and complications were reported by nurses.
RESULTS
Overall frequency of BPSD was higher in patients with dementia (76%) than without (38%). The most frequent symptoms in patients with dementia were nighttime disturbances (38%), depression (29%) and aberrant motor behaviour (28%) and the most distressing symptoms for nursing staff were delusions, aggression and nighttime disturbances. The overall frequency of BPSD increased from 67% in mild dementia, to 76% in moderate dementia and to 88% in severe dementia. The most frequent symptoms in patients without dementia were depression (19%), nighttime disturbances (13%) and irritability (13%). The most distressing symptoms were aggression and delusions, while the same symptoms were consistently rated as less distressing than in patients with dementia. Factor analysis revealed three independent groups of BPSD that explained 45% of the total variance. First, expansive symptoms (aggression, irritability, nighttime disturbances, aberrant motor behaviour and disinhibition) were frequent, distressing for nursing staff and associated with many complications. Second, psychotic symptoms (delusions and hallucinations) were infrequent, distressing and associated with some complications. Third, affective symptoms (apathy, anxiety and depression) were frequent, non-distressing and associated with few complications. The results did not change when cases with delirium were excluded from both groups.
CONCLUSIONS
BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.
目的
关于痴呆的行为和心理症状（BPSD）在综合医院中的表现，人们知之甚少。本研究旨在调查综合医院中 BPSD 的发生率及其与护理人员的困扰和护理并发症的关系。
方法
这是一项在德国 33 家随机选择的综合医院中进行的横断面代表性研究，纳入了 1469 名年龄≥65 岁的患者，其中包括 270 名痴呆患者。护士报告了 BPSD 和并发症。
结果
痴呆患者的 BPSD 总发生率（76%）高于非痴呆患者（38%）。痴呆患者最常见的症状是夜间障碍（38%）、抑郁（29%）和异常运动行为（28%），而对护理人员最困扰的症状是妄想、攻击和夜间障碍。总体而言，BPSD 的发生率从轻度痴呆的 67%增加到中度痴呆的 76%，再增加到重度痴呆的 88%。非痴呆患者最常见的症状是抑郁（19%）、夜间障碍（13%）和易怒（13%）。最困扰的症状是攻击和妄想，而这些症状的困扰程度始终低于痴呆患者。因子分析显示，BPSD 有三个独立的分组，解释了总方差的 45%。首先，扩张性症状（攻击、易怒、夜间障碍、异常运动行为和抑制丧失）较为常见，给护理人员带来困扰，并与许多并发症相关。其次，精神病性症状（妄想和幻觉）不常见，给护理人员带来困扰，与一些并发症相关。第三，情感症状（冷漠、焦虑和抑郁）较为常见，不困扰护理人员，与较少的并发症相关。当从两个组中排除谵妄病例时，结果没有改变。
结论
痴呆患者在综合医院中较为常见，其 BPSD 与护理人员的高度困扰以及广泛的特殊治疗需求和额外的行为和医学并发症有关。需要管理策略来改善患者和医院工作人员的情况。
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