Zusammenfassung
Das Delir, eine akute Verschlechterung kognitiver Funktionen und der Aufmerksamkeitsfähigkeit, ist die häufigste psychische Störung bei älteren Menschen. Die richtige Diagnose und ein adäquates Management sind für die weitere Gesundheit und Selbstständigkeit der Betroffenen entscheidend. Die Primärprävention dieses komplexen, potenziell lebensgefährlichen Problems umfasst das Erkennen der Risikopatienten, Vermeiden von Umgebungsstress und kausalen Faktoren, wie z. B. anticholinerge Medikamente, insbesondere bei kognitiv bereits kompromittierten Patienten, sowie ein rechtzeitiges Reagieren auf Prodromalsymptome. Eine kausale Therapie, d. h. die Behandlung der auslösenden Erkrankung und Beseitigung der mitverursachenden Situation, ist unumgänglich. Sie wird begleitet durch pflegerische und milieutherapeutische Maßnahmen sowie bei Bedarf durch eine antipsychotische und/oder sedierende symptomatische Therapie.
Abstract
Delirium, the acute deterioration of cognitive function and attention, is the most frequent mental disorder in elderly. Its correct diagnosis and adequate management are of crucial importance for the patient’s health and functional outcome. First of all, one has to be aware of the possibilities of preventing this complex, potentially life-threatening problem, which means recognizing the patient at risk, avoiding environmental stress and causal factors (i.e., anticholinergic medication) in cognitively impaired patients, and timely reaction to prodromal symptoms. Causal therapy (i.e., treatment of the causal condition and/or eliminating the precipitating situation) is imperative. It must be accompanied by nursing and environmental measures and, if necessary, by antipsychotic and/or sedating symptomatic treatment.
Literatur
Hommel A, Kock ML et al (2012) The patient’s view of nursing care after hip fracture. ISRN Nurs 2012:863291. DOI 10.5402/2012/863291
Sörensen DG, Wikblad K (2007) Patients‘ experiences of being delirious. J Clin Nurs 16(5):810–818
National Institute for Health and Clinical Excellence (NICE) (2010) Delirium: diagnosis, prevention and management. NICE, London, UK
Inouye SK, Westendorp RG et al (2013) Delirium in elderly people. Lancet (Epub ahead of print). DOI 10.1016/S0140-6736(13)60688-1
Leslie DL, Inouye SK (2011) The importance of delirium: economic and societal costs. J Am Geriatr Soc 59(Suppl 2):241–243
Hasemann W, Kressig R et al (2007) Delirium: screening, assessment and diagnosis. Pflege 20(4):191–204
Inouye SK (2006) Delirium in older persons. N Engl J Med 354(11):1157–1165
Flacker JM, Cummings V et al (1998) The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry 6(1):31–41
Cerejeira J, Firmino H et al (2010) The neuroinflammatory hypothesis of delirium. Acta Neuropathol 119(6):737–754
Carnahan RM, Lund BC et al (2006) The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol 46(12):1481–1486
Boustani MA et al (2008) Impact on anticholinergics on the aging brain: a review and practical application. Aging Health 4(3):311–320
Cai X, Campbell N et al (2013) Long-term anticholinergic use and the aging brain. Alzheimers Dement 9(4):377–385
Campbell N, Perkins A et al (2011) Association between prescribing of anticholinergic medications and incident delirium: a cohort study. J Am Geriatr Soc 59(Suppl 2):277–281
Chew ML, Mulsant BH et al (2008) Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 56(7):1333–1341
Rudolph JL, Salow MJ et al (2008) The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med 168(5):508–513
Pils K, Österreichische Gesellschaft für Geriatrie und Gerontologie (Hrsg) (2013) Polypharmazie 2013. Facultas, Wien
Dilling H et al (2011) Internationale Klassifikation psychischer Störungen ICD-10 Kapitel V (F), 8. Aufl. Huber, Bern
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington
Schuurmans MJ et al (2003) The Delirium observation screening scale: a screening instrument for delirium. Res Theory Nurs Pract 17:31–50
Inouye SK et al (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Int Med 113:941–948
Flanagan NM, Fick DM (2010) Delirium superimposed on dementia. Assessment and intervention. J Gerontol Nurs 36(11):19–23
Ely EW, Margolin R et al (2001) Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 29(7):1370–1379
Pandharipande PP, Girard TD et al (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369(14):1306–1316
AWMF S3-Leitlinie (2009) Analgesie, Sedierung und Delirmanagement in der Intensivmedizin. http://www.awmf.org/uploads/tx_szleitlinien/001-012l.pdf. Zugegriffen: 7. Nov. 2013
Quinlan N, Marcantonio ER et al (2011) Vulnerability: the crossroads of frailty and delirium. J Am Geriatr Soc 59(Suppl 2):262–268
Siddiqi N, House AO et al (2006) Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 35(4):350–364
Carr FM (2013) The role of sitters in delirium: an update. Can Geriatr J 16(1):22–36
Grue EV, Kirkevold M et al (2009) Prevalence of vision, hearing, and combined vision and hearing impairments in patients with hip fractures. J Clin Nurs 18(21):3037–3049
Lonergan E, Luxenberg J et al (2009) Benzodiazepines for delirium. Cochrane Database Syst Rev 4:CD006379
Trzepacz PT (1996) Delirium. Advances in diagnosis, pathophysiology, and treatment. Psychiatr Clin North Am 19(3):429–448
Pascala JT, Sullivan GM (eds) (2010) Geriatric review syllabus: a core curriculum in geriatric medicine, 7th edn. The American Geriatrics Society, New York, USA
Hammann F, Drewe J (2010) Medikamentöse Therapeiansätze des Delirs. Ther Umsch 67(2):91–94
Einhaltung ethischer Richtlinien
Interessenkonflikt. T. Frühwald, M. Weissenberger-Leduc, C. Jagsch, K. Singler, S. Gurlit, W. Hofmann, B. Böhmdorfer und B. Iglseder geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Frühwald, T., Weissenberger-Leduc, M., Jagsch, C. et al. Delir. Z Gerontol Geriat 47, 425–440 (2014). https://doi.org/10.1007/s00391-014-0613-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00391-014-0613-1