Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts.
Department of Neurology, New York Langone Health, New York University Grossman School of Medicine, New York City, New York.
Semin Neurol. 2024 Dec;44(6):752-761. doi: 10.1055/s-0044-1788976. Epub 2024 Aug 29.
Disparities exist in the identification, treatment, and management of delirium. These disparities can be most holistically and comprehensively understood by using a social-ecological model-which acknowledges multilevel impacts including individual, interpersonal, organizational, community, and policy-level factors-as well as a social determinant of health framework, that considers nonmedical factors that influence health outcomes. This narrative review leverages both frameworks to identify and discuss existing literature pertaining to the intersection of these social risk factors and delirium, focusing specifically on disparities due to racial and/or ethnic identity, language ability, and socioeconomic differences. We also look at disparities and the potential role of these social risk factors throughout the continuum of care, including prehospitalization, hospitalization, and posthospitalization factors. Understanding and analyzing the role of these inequities is critical to ensuring better health outcomes for patients at risk of and/or with delirium.
在谵妄的识别、治疗和管理方面存在差异。这些差异可以通过使用社会生态学模型——承认包括个人、人际、组织、社区和政策层面因素在内的多层次影响,以及考虑影响健康结果的非医疗因素的健康社会决定因素,最全面和全面地理解。本叙述性评论利用这两个框架来确定和讨论与这些社会风险因素和谵妄交叉相关的现有文献,特别关注种族和/或族裔身份、语言能力和社会经济差异造成的差异。我们还研究了整个护理过程中的差异和这些社会风险因素的潜在作用,包括住院前、住院期间和出院后因素。了解和分析这些不平等现象的作用对于确保处于谵妄风险中或患有谵妄的患者获得更好的健康结果至关重要。