運用「住院老年患者生活項目」建構中文化「老年患者術後譫妄預防的多學科綜合處置模式」

Localization Establishment of an Interdisciplinary Intervention Model to Prevent Post-Operative Delirium in Older Patients Based on ‘Hospital Elder Life Program’

背景譫妄是老年患者術後常見的重要併發症。譫妄的發生可能導致患者身心風險增加，住院時間延長，甚至死亡。基於實證模式，運用多學科綜合處置，可有效預防譫妄並縮短住院節約成本。目的建構中文化適用於預防老年患者術後譫妄的多學科綜合處置模式。方法本研究引進哈佛醫學院老年醫學研究中心原版Hospital Elder Life Program多學科綜合處置模式，結合在地資源，經中文翻譯改良，參考美國醫學研究所（Institute of Medicine）標準，以英國國家衛生與臨床優化研究所（National Institute for Health and Clinical Excellence）2010年制定的《譫妄診斷、預防和管理》指南，及2014年美國老年醫學會制定的《老年患者術後譫妄臨床實踐指南》，更新發展為多學科綜合處置模式；再經討論、諮詢、患者預試等步驟修訂完成。結果初步構建了適用於中國醫療環境的預防術後譫妄的多學科綜合處置模式，內容包括：人員構成與職責分工，多學科綜合處置方案的具體內容及實施流程，以及團隊成員培訓等。結論期望透過中文化改良的多學科綜合處置模式，能減少老年患者術後譫妄及其他併發症的發生，維護且改善其功能，縮短住院時間及促進康復。

Background: Postoperative delirium is a significant complication in elderly patients. The occurrence of delirium may increase the related physical and psychological risks, delay the length of hospital stays, and even lead to death. According to the current evidence-based model, the application of interdisciplinary intervention may effectively prevent delirium, shorten the length of hospital stays, and save costs. Purpose: To establish a culturally appropriate interdisciplinary intervention model for preventing postoperative delirium in older Chinese patients. Methods: The authors adapted the original version of the Hospital Elder Life Program (HELP©) from the Hebrew Senior Life Institute for Aging Research of Harvard University by localizing the content using additional medical resources and translating the modified instrument into Chinese. Furthermore, the final version of this interdisciplinary intervention model for postoperative delirium was developed in accordance with the “guideline of delirium: diagnosis, prevention and management produced by the National Institute for Health and Clinical Excellence in 2010” and the “clinical practice guideline for postoperative delirium in older adults” produced by American geriatrics society in 2014. Finally, the translated instrument was revised and improved using discussions, consultations, and pilot study. Results: The abovementioned procedure generated an interdisciplinary intervention model for preventing postoperative delirium that is applicable to the Chinese medical environment. The content addresses personnel structure and assignment of responsibility; details of interdisciplinary intervention protocols and implementation procedures; and required personnel training. Conclusions: The revised model is expected to decrease the occurrence of post-operative delirium and other complications in elderly patients, to help them maintain and improve their function, to shorten the length of their hospital stays, and to facilitate recovery.