Ibrahim Joseph Elias, Anderson Laura J, MacPhail Aleece, Lovell Janaka Jonathan, Davis Marie-Claire, Winbolt Margaret
Department of Forensic Medicine, Monash University, Southbank.
Ballarat Health Services, Ballarat.
J Multidiscip Healthc. 2017 Jan 25;10:49-58. doi: 10.2147/JMDH.S121626. eCollection 2017.
The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person's ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure) varies according to the cognitive domain(s) affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function) impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient's current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient's skill set. The increasing prevalence of age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level.
痴呆症患者的慢性病负担更重，随着人口老龄化，这一患者群体正在不断增加。慢性病最佳管理的基石是有效的患者自我管理。然而，对于患有痴呆症合并症的老年人来说，这尤其具有挑战性。痴呆症对一个人自我管理其慢性病（如糖尿病或心力衰竭）能力的影响因受影响的认知领域、损伤严重程度和自我护理任务的复杂性而异。本文提出了一个框架，描述了认知领域（注意力和信息处理、语言、视觉空间能力和实践、学习和记忆以及执行功能）的损伤如何影响慢性病自我管理的五个关键过程。认识到慢性病患者患有痴呆症可能会带来更好的结果。患有痴呆症的患者需要量身定制的策略，以适应并调整到个体以及受损的认知领域，从而优化他们的自我管理能力。本文提出的框架还详细介绍了临床医生应对因认知领域不同程度受损导致的自我管理不善的管理策略。临床医生应与患者和护理人员合作，评估患者当前的能力，识别成功自我管理的潜在障碍，并根据患者的技能水平努力调整信息提供方式。与年龄相关的慢性病患病率不断上升，加上非正式护理人员的数量减少，这就需要创新项目来支持初级保健层面的自我管理。
