Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Geriatric Clinic, Medicine-Geriatric-Rehabilitation Department, University of Parma, and University Hospital, 43126 Parma, Italy, Italy.
Int J Mol Sci. 2020 Mar 31;21(7):2397. doi: 10.3390/ijms21072397.
The presentation of common acute diseases in older age is often referred to as "atypical". Frequently, the symptoms are neither single nor tissue related. In most cases, the onset of symptoms and diseases is the expression of a diminished reserve with a failure of the body system and imbalance of brain function. Delirium is one of the main devastating and prevalent atypical symptoms and could be considered as a geriatric syndrome. It encompasses an array of neuropsychiatric symptoms and represents a disarrangement of the cerebral function in response to one or more stressors. The most recent definition, reported in the DSM-V, depicts delirium as a clear disturbance in attention and awareness. The deficit is to be developed in a relatively short time period (usually hours or days). The attention disorder must be associated with another cognitive impairment in memory, orientation, language, visual-spatial or perception abilities. For the treatment, it is imperative to remove the potential causes of delirium before prescribing drugs. Even a non-pharmacological approach to reducing the precipitating causes should be identified and planned. When we are forced to approach the pharmacological treatment of hyperactive delirium in older persons, we should select highly cost-effective drugs. High attention should be devoted to the correct balance between improvement of psychiatric symptoms and occurrence of side effects. Clinicians should be guided in the correct choice of drugs following cluster symptoms presentation, excluding drugs that could potentially produce complications rather than advantages. In this brief point-of-view, we propose a novel pharmacological flow-chart of treatment in relation to the basic clusters of diseases of an older patient acutely admitted to the hospital and, in particular, we emphasize "What We Should Not Do!", with the intention of avoiding possible side effects of drugs used.
老年人常见急性疾病的表现通常被称为“非典型”。这些症状往往既不是单一的，也不是与组织相关的。在大多数情况下，症状和疾病的发作是身体系统储备能力下降和大脑功能失衡的表现。谵妄是主要的破坏性和普遍存在的非典型症状之一，可以被认为是一种老年综合征。它包含一系列神经精神症状，代表大脑功能对一个或多个应激源的紊乱。DSM-V 中报告的最新定义将谵妄描述为注意力和意识的明显障碍。这种缺陷是在相对较短的时间内（通常是几个小时或几天）发展起来的。注意力障碍必须与记忆、定向、语言、视觉空间或感知能力的另一种认知障碍相关。对于治疗，在开处方之前必须消除谵妄的潜在原因。即使是针对减少诱发因素的非药物方法也应该被确定和计划。当我们被迫采用药物治疗老年人激越性谵妄时，我们应该选择高性价比的药物。应该高度关注改善精神症状和出现副作用之间的正确平衡。临床医生应该根据集群症状的表现，在正确选择药物时排除可能产生并发症而不是优势的药物。在这篇简要的观点文章中，我们提出了一种与急性住院老年患者基本疾病集群相关的新型药物治疗流程图，特别是我们强调了“我们不应该做什么！”，目的是避免使用药物可能产生的副作用。
