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Das Delir im höheren Lebensalter

Delirium in the elderly

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Zusammenfassung

Ein Delir ist eine häufige, ernsthafte und lebensbedrohliche Komplikation stationärer Behandlung älterer Menschen. Das Delir primär oder sekundär im Rahmen einer anderen Erkrankung ist zugleich häufig Anlass für eine Krankenhausbehandlung. Die Genese ist multifaktoriell und derzeit nicht restlos geklärt, wobei Veränderungen der Neurotransmitter eine Schlüsselrolle spielen. Die Inzidenz kann in einem entsprechenden Setting bis zu 90% erreichen, aber auch häufig durch geeignete Interventionen abgemildert, rückgebildet oder gänzlich verhindert werden. Das Delirium weist eine erhöhte Kurz- und Langzeitmortalität auf, prädestiniert zu weiteren (iatrogenen) Komplikationen, funktionellen Einschränkungen und stellt ein hohes Risiko für ein verbleibendes oder sich zukünftig entwickelndes kognitives Defizit und dementielles Syndrom dar. Delirante Symptome können Behandlungsdauer verlängern und erhöhen die unmittelbaren Kosten wie auch den Ressourcenverbrauch einschl. erhöhter Institutionalisierungsrate im weiteren poststationären Verlauf. Ein strukturiertes diagnostisches und therapeutisches Vorgehen ist geboten. Das Delir sollte zukünftig ein Qualitätsindikator für die stationäre Behandlung werden, obwohl viele Forschungsfragen zum jetzigen Zeitpunkt noch nicht beantwortet sind.

Abstract

Delirium is a common, serious medical and often life-threatening condition in elderly in-patients. Delirium can develop primarily or secondarily related to other medical conditions and lead to hospital admission. The pathogenesis is still not fully known and is usually addressed as multifactorial. Alterations in neurotransmitters have a key role in this process. The incidence varies by setting up to 90%. Delirium is associated with increased short- and long-term mortality, iatrogenic complications, functional decline, and future development of cognitive impairment or dementia. Delirium is also associated with longer hospital stays, higher hospital and total health system costs, and an increasing rate of nursing home admissions. A structured diagnostic and therapeutic process is recommended. Delirium should become a quality indicator for hospital medicine; however, many research questions still exist.

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  1. Klinik für Geriatrie, Krankenhaus Lindenbrunn, Lindenbrunn 1, 31863, Coppenbrügge, Germany

    Manfred Gogol

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Gogol, M. Das Delir im höheren Lebensalter. Z Gerontol Geriat 41, 431–439 (2008). https://doi.org/10.1007/s00391-008-0019-z

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