長照機構中之失智症患者併譫妄

Delirium on Superimpose of Dementia in Long Term Care

譫妄為年長者常見且容易被忽略的老年症候群之一，而在失智症患者的發生率也 高，並且較不容易被診斷，因為失智與譫妄彼此有太多重疊的症狀表現，此時住民在 長照機構基礎認知功能狀態建立就很重要，一旦住民發生狀況，醫師、護理師或是照 顧服務員便能知道這現象可能譫妄還是原本的失智狀態造成。假如尚未建立完整的基 礎評估，工作人員可以與家屬或照顧者詢問住民的日常生活能力與認知狀態。照護者 需要特別了解，譫妄是一種急性、可恢復且需要立即處理的現象，就像發燒一樣，是 身體警訊的一種表現，處理譫妄就是要處理根本的問題，通常根本的問題是生理上的 異常所造成的，有可能是單一因子，但是通常是多因子造成譫妄，在譫妄處理結束後， 須與家屬小心的溝通，預防譫妄才是最佳的照護策略，如此才能讓年長者有較好的預 後與生活功能，維持生活品質。

Delirium is one of the common components of geriatric syndrome and a prevalent problem in long-term care facilities. The incidence of delirium in dementia patient is high and less likely to be diagnosed. Dementia and delirium have too many overlapping symptoms of each other. In addition, their prior cognitive impairment makes detecting their delirium a challenge. Establishing a baseline cognitive status is important. Once the residents of the situation, physician or care workers will be able to know this phenomenon may be delirium or the original state of dementia caused. If there's not a complete medical record, the nurse should determine the patient's usual ability to perform activities of daily living and instrumental activities of daily living by talking to someone who knows the patient. Delirium often results from an interaction of factors: those specific to the patient and those related to hospital care, such as the use of restraints and new medications. Certain environmental stimuli and processes of care can also increase the risk of delirium. Discussing the outcomes with family should be done seriously. Educate and counsel family regarding signs of re-occurrence and duration of delirium is necessary. Therefore, the elderly can have a better prognosis and physical function, to maintain the quality of life.