以實證觀點探討老年髖骨骨折術後瞻妄之照護

Evidence-Based Nursing Care of Older Adult Patient With Postoperative Delirium and Hip Fracture

髖骨骨折好發於65歲以上老年人，其發生率為756人／每十萬人口，髖部骨折手術是老年人最常見之緊急手術；然而，術後瞻妄發生率約5％–61％，病人會出現意識、注意力、知覺、思維、記憶、精神活動、情緒和睡眠障礙，若處置不當可能衍生許多併發症，甚至引起死亡，同時也增加醫療費用和家屬的負擔，故醫護人員需及早評估、減少加速因子、提供適度照護。然而，臨床上因術後瞻妄不易診斷及分辨，故容易被醫護人員忽略而無法給予妥當照護。本文藉由實證文獻回顧提出譫妄定義、相關生理病理機轉及導因、醫療處置及照護重點，在臨床上，醫護人員可運用瞻妄評估工具辨識出高風險病人、早期診斷、及早啟動老年生活計畫和老年醫學諮詢，予以疼痛控制、營養及體液補充，增加病人的感官及認知功能，以減少瞻妄的發生、縮短住院時間，降低併發症及院內死亡率，進而提升對老年髖骨骨折術後病人及其照顧者之照護品質。

Hip fracture commonly occurs in adult patients over 65 years old at a prevalence rate that is estimated to be 756 per 100 thousand cases. Thus, hip fracture surgery is one of the most common emergency operations in older adult populations. In addition, the incidence rate in older adults of post-operative delirium, which leads to symptoms of disturbance related to cognition, attention, perception, logic, memory, psychological activities, mood, and sleep, has been reported as 5%–61%. The many possible complications of post-operative delirium, including death, increase medical costs and family burdens if not managed properly. Proper management involves healthcare providers initiating early assessments, reducing accelerated factors, and providing appropriate care. As diagnosing and differentiating post-operative delirium in clinical practice is difficult, this condition is easily neglected by healthcare teams, resulting in adequate care not being provided to this population. The aim of this paper was to review the definition, relevant physiological and pathological mechanisms and etiologies, and medical management and nursing care of post-operative delirium using an evidence-based literature review. Suggestions for healthcare providers to improve the detection and management of post-operative delirium include using appropriate evaluation tools to detect and diagnose high-risk patients as early as possible, implementing older-adult life planning strategies, and conducting medical consultations. Furthermore, healthcare providers may initiate pain control, nutrient and body fluid supplementation, and sensory/cognition enhancement therapies to reduce the incidence of delirium, length of hospital stay, complications, and in-hospital mortality, thereby improving the quality of care provided to older adult patients with hip fractures and their caregivers.