Delirium en el anciano: guía clínica integral para su diagnóstico y tratamiento
Resumen
Introducción: Los ancianos tienen un mayor riesgo de presentar delirium debido a factores como la edad avanzada, demencia y deterioro cognitivo y funcional. Su prevalencia varía según el grupo de pacientes y el entorno. Objetivo: Sintetizar y analizar críticamente el conocimiento actual sobre la definición, características clínicas, diagnóstico y tratamiento del delirium en ancianos. Metodología: Se realizó una búsqueda sistemática en bases de datos, utilizando términos MeSH y DeCs: “Delirium”, “Cognitive Dysfunction”, “Dementia”, “Aged”, “Clinical Protocols” y “Coronavirus Infections”. Se incluyeron artículos publicados hasta el 30 de mayo de 2021, seleccionando 50 artículos basados en criterios de inclusión y exclusión establecidos por los autores. Resultados: En los ancianos, el delirium ocurre por una falla cerebral que reduce la capacidad de respuesta a un factor estresante agudo, siendo la disfunción colinérgica el mecanismo más frecuente. Es común en pacientes hospitalizados, con una prevalencia del 23% en pacientes no quirúrgicos. En pacientes postquirúrgicos, la prevalencia varía, alcanzando hasta un 20% en aquellos sometidos a cirugía mayor. Las restricciones generadas por la pandemia de COVID-19 aumentaron la incidencia de delirium en ancianos, presentándose de manera más severa. Es esencial usar herramientas estandarizadas para la detección del delirium en la práctica clínica. No existen pruebas de laboratorio específicas para su diagnóstico y no se recomienda de rutina el uso de estudios de neuroimagen. Las estrategias no farmacológicas con componentes múltiples han demostrado reducir su incidencia. Conclusión: El delirium es una condición multifactorial que genera alta morbimortalidad en los ancianos. El manejo farmacológico sigue siendo un desafío en su tratamiento
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Derechos de autor 2024 Danna Sarmiento Dickson , Luis Felipe Ordosgoitia Dickson, Daniela Álzate Hoyos, Sebastián Enrique Santana Araujo, Daniela María Herdenes García, Eyver Enrique Ibarra Olivella, Oscar Vergara Serpa
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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