Inouye S K
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Am J Med. 1994 Sep;97(3):278-88. doi: 10.1016/0002-9343(94)90011-6.
Delirium, with occurrence rates from 14% to 56%, associated mortality rates from 10% to 65%, and excess annual health care expenditures from $1 to $2 billion, poses a common and serious problem for hospitalized elderly patients. Delirium is often unrecognized or misdiagnosed by physicians caring for elderly patients. Cognitive testing is rarely done as part of the admission evaluation of elderly hospitalized patients. Specific diagnosis has been difficult, since diagnostic criteria and instruments are still being developed. The etiology of delirium is complex and multifactorial, and both predisposing (host vulnerability) and precipitating factors must be considered. The recommended approach to the evaluation of delirium is empiric, in the absence of objective efficacy data. The cornerstone of evaluation includes a careful history, physical examination, and review of the medication list--since medications are the most common reversible cause of delirium. Research is needed to establish a cost-effective approach and to clarify the role of further testing, such as cerebrospinal fluid examination, brain imaging, and electroencephalography. This article is intended to heighten the awareness of clinicians as well as to stimulate research to address this important, neglected problem for elderly hospitalized patients.
谵妄在住院老年患者中是一个常见且严重的问题，其发生率为14%至56%，相关死亡率为10%至65%，每年额外的医疗保健支出达10亿至20亿美元。谵妄常常未被照料老年患者的医生识别或误诊。认知测试很少作为老年住院患者入院评估的一部分进行。由于诊断标准和工具仍在开发中，所以具体诊断一直很困难。谵妄的病因复杂且多因素，必须同时考虑易感因素（宿主易感性）和促发因素。在缺乏客观疗效数据的情况下，推荐的谵妄评估方法是经验性的。评估的基石包括仔细询问病史、体格检查和审查用药清单，因为药物是谵妄最常见的可逆转病因。需要开展研究以建立一种具有成本效益的方法，并阐明进一步检查（如脑脊液检查、脑成像和脑电图）的作用。本文旨在提高临床医生的认识，并激发相关研究，以解决这个针对老年住院患者的重要且被忽视的问题。
