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Vitglöp og óráð meðal aldraðra bráðasjúklinga á lyflækningadeild

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Authors
Halldór Kolbeinsson
Ársæll Jónsson
Issue Date
1991-04-01

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Læknablaðið 1991, 77(4):141-9
Abstract
A prospective study of 272 patients, 70 years and older, admitted as an emergency to the medical department at Borgarspitalinn, Reykjavik, Iceland, was carried out to evaluate the causes, outcome and prevalence of delirium and dementia. Cognitive function was assessed with Mental Status Questionnaire (MSQ) and Mini-Mental State Examination (MMSE) and further evaluated by Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM-III-R) for delirium and dementia. Severe cognitive dysfunction was present in 32% of all acute medical admissions further evaluated as dementia 18.4% and delirium in 13.6%. Concurrent dementia was also found in 70% of delirious patients. Mean age of patients with dementia was 85 years, but 81 years with delirium. The mortality rate of delirious patients was 32% and the main causes of delirium was congestive cardiac failure (27%) and severe infections (30%). The mortality rate for dementia alone was 8%. Cognitive dysfunction is common among acute medical elderly patients and special emphasis of care will be needed for patients in delirious states.
Athuguð var tíðni vitglapa (dementia) og óráðs (delirium) meðal aldraðra bráðasjúklinga sjötíu ára og eldri á lyflækingadeild Borgarspítalans. Markmiðið var að kanna hversu algeng vitglöp og óráð væru meðal þeirra og jafnframt að finna ástæður óráðs, kanna lyfjanotkun og félagslegar aðstæður. Vitglöp verða hér eftir nefnd glöp. Af öllum bráðainnlögðum sjúklingum reyndust 45% vera sjötíu ára og eldri. Hægt var að skima 272 sjúklinga og reyndust 32% þeirra hafa skilvitlega truflun. Nánari greining leiddi í ljós óráð hjá 13.6% og glöp hjá 18.6%. Í óráðshópnum reyndust tuttugu og sex sjúklingar einnig hafa merki um glöp, þannig að í heild reyndust 28% sjúklingar hafa miðlungs- og alvarleg glöp. Meðalaldur sjúklinga með glöp var um 85 ár, meirihluti voru einhleypar konur úr Reykjavik og komu að mestum hluta frá stofnun fyrir aldraða. Algengasta einkenni við innlögn var hósti, hiti, mæði eða slappleiki. Meðalfjöldi einstakra lyfja var 3.7 og algengasti lyfjafiokkurinn var hjartalyf og þar næst tauga- og geðlyf. Sjúklingar með óráð voru mikið veikir og dó um þriðjungur þeirra á sjúkrahúsinu en 8% þeirra sem eingöngu höfðu glöp létust. Algengustu ástæður óráðs voru alvarlegar sýkingar (30%) og hjartabilun (27%). Rannsóknin sýndi að aldraðir sjúklingar sem fá óráð hafa verulega skertar batahorfur og meta þarf nákvæmlega einkenni þeirra og meðferð. Skima þarf sérstaklega eftir skilvitlegri truflun meðal aldraðra sjúklinga til að finna þá sem hafa glöp og óráð. Einfóld skimpróf, eins og Mental Status Questionnaire
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