Thomas Christine, Spank Juliane, Weller Sarah, Eschweiler Gerhard W
Klinik für Psychiatrie und Psychotherapie für Ältere, Zentrum für Seelische Gesundheit, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen, Deutschland.
Z Gerontol Geriatr. 2021 Dec;54(8):759-767. doi: 10.1007/s00391-021-01988-3. Epub 2021 Nov 24.
Cognitive impairment is common among older patients in German hospitals (40%). Dementia, other brain diseases and frailty significantly increase the risk of delirium and pose great challenges to interdisciplinary and interprofessional teams. Delirium prevention is achievable but requires complex interdepartmental strategies with specific components for timely recognition of the individual delirium risk, to carry out structured and sustained implementation of appropriate measures for delirium prevention as well as prompt etiological diagnostics and immediate treatment when delirium occurs.
The present work aims to shed light on the role of interprofessional and interdisciplinary collaboration in evidence-based, nonpharmacological delirium prevention programs.
Narrative review of international best practice programs.
Nonpharmacological prevention of delirium is effective but requires differentiated risk identification, regular delirium screening and daily targeted cognitive activation and sleep promotion. This can only be achieved in close interprofessional collaboration and is mostly carried out interdepartmentally by specialized teams.
Interprofessional multicomponent programs for delirium prevention hold the potential to reduce delirium and complication rates in older high-risk patients in regular care, thereby improving treatment and long-term quality of life. Additional interprofessional delirium prevention teams are deployed in different settings simultaneously and provide regular training on optimal delirium management. Demonstration of the effectiveness of cross-setting programs requires large multicenter studies and is therefore particularly laborious.
认知障碍在德国医院的老年患者中很常见（40%）。痴呆症、其他脑部疾病和身体虚弱会显著增加谵妄的风险，给跨学科和跨专业团队带来巨大挑战。谵妄预防是可以实现的，但需要复杂的部门间策略，包括及时识别个体谵妄风险的特定组成部分，对谵妄预防措施进行结构化和持续的实施，以及在谵妄发生时进行迅速的病因诊断和立即治疗。
本研究旨在阐明跨专业和跨学科合作在循证非药物性谵妄预防项目中的作用。
对国际最佳实践项目进行叙述性综述。
非药物性谵妄预防是有效的，但需要进行差异化的风险识别、定期的谵妄筛查以及每日有针对性的认知激活和睡眠促进。这只有在紧密的跨专业合作中才能实现，并且大多由专业团队在部门间开展。
跨专业多组分谵妄预防项目有潜力降低常规护理中高危老年患者的谵妄和并发症发生率，从而改善治疗效果和长期生活质量。额外的跨专业谵妄预防团队同时在不同环境中部署，并提供关于最佳谵妄管理的定期培训。证明跨环境项目的有效性需要大型多中心研究，因此特别费力。
