長照體系內譫妄症與急性問題行為之評估與處置

Assessment and Management of Delirium and Acute Problematic Behavior in the Long-Term Care Setting

譫妄症是一種嚴重而複雜的症候群，且在所有醫療照護體系相當常見，包括長期 照護體系。在長期照護體系中，譫妄症會造成相當程度的併發症及死亡，對醫療專業 人員而言是相當大的挑戰。在長期照護體系中，譫妄症及急性問題行為相當常見。面 對有急性問題行為的病患，若懷疑有譫妄症，應立即給予評估和處置。為了改善長期 照護體系中的照護品質，美國醫療主管學會（American Medical Directors Association） 針對長照體系內譫妄症與急性問題行為發展出一套臨床診療指引。該指引的特色為提 供十五個步驟的系統性評估，包括辨識、評估、處置及監測四大部分。本文將介紹美 國醫療主管學會在長照體系內譫妄症與急性問題行為的指引，並回顧相關診治的最新 進展。

Delirium is a serious, complex syndrome, commonly encountered across all healthcare settings, including long-term care (LTC) setting. Delirium leads to substantial morbidity and mortality in LTC settings, and presents a huge challenge to healthcare professionals. If a patient with acute problematic behavior is suspected to have delirium, he/she needs immediate medical attention. To improve the quality of care delivered to residents in long-term care facilities, the American Medical Directors Association (AMDA) developed a clinical practice guideline on delirium and acute problematic behavior in the long-term care setting. The guideline features a 15-step systematic approach to recognizing, assessing, treating and monitoring long-term care residents with delirium and acute problematic behavior. The current article reviews the AMDA guideline and provides an update for delirium and acute problematic behavior in long-term care settings.