谵妄和痴呆有什么区别？
What is the difference between delirium and dementia?
谵妄是急性起病、波动明显的注意力与意识障碍，常在数小时到数天内出现，多由感染、脱水、疼痛、缺氧、便秘或药物等可纠正的诱因引起，去除诱因后多可恢复。痴呆是慢性、逐渐进展的认知功能衰退，以记忆和执行功能受损为主，病程以年计。两者可以叠加：痴呆患者住院时发生谵妄的风险很高。预防谵妄主要靠非药物手段——保持定向提示、白天活动、夜间安静、及时补水、控制疼痛并减少不必要的镇静药。
Delirium is an acute, markedly fluctuating disturbance of attention and awareness that develops over hours to days, usually triggered by correctable causes such as infection, dehydration, pain, hypoxia, constipation or medication, and it often resolves once the trigger is removed. Dementia is a chronic, gradually progressive decline in cognition, dominated by memory and executive dysfunction, unfolding over years. The two can overlap: hospitalized people with dementia are at high risk of delirium. Prevention is mainly non-pharmacological - orientation cues, daytime mobility, quiet nights, adequate hydration, pain control and avoiding unnecessary sedatives.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 已核验 · Verified 2026-08-23 · 2 条独立证据
来源 · Source
Harrison's Principles of Internal Medicine 第20版,McGraw-Hill,2018
J. Loscalzo et al., Harrison's Principles of Internal Medicine, 20th ed., McGraw-Hill, 2018
独立核验依据 · Independent verification: 核验依据 2 OPENLIBRARY ISBN 标识 9781259644047（按标识回读: Harrison's prin
#谵妄 #痴呆 #急性意识障碍 #非药物预防
为什么老年人对同样剂量的药物更敏感？
Why are older adults more sensitive to the same drug dose?
随年龄增长，肾小球滤过率下降使经肾排出的药物蓄积；肝血流和部分代谢酶活性降低延长了药物半衰期。同时身体成分改变：体液和瘦体重减少使水溶性药物血药浓度升高，脂肪比例增加使脂溶性药物（如某些镇静药）滞留更久。加上中枢神经系统对镇静、抗胆碱作用更敏感，以及常见的多重用药相互作用，老年用药原则是“小剂量起始、缓慢加量”，并定期按Beers标准等工具复核用药清单。
With age, a falling glomerular filtration rate lets renally cleared drugs accumulate, while reduced hepatic blood flow and some enzyme activity lengthen half-lives. Body composition also shifts: less body water and lean mass raise the concentration of water-soluble drugs, while a higher fat fraction keeps lipophilic drugs such as certain sedatives in the body longer. Add heightened central nervous system sensitivity to sedation and anticholinergic effects, plus interactions from common polypharmacy, and the rule becomes “start low, go slow”, with regular medication reviews using tools such as the Beers Criteria.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 已核验 · Verified 2026-08-23 · 2 条独立证据
来源 · Source
Harrison's Principles of Internal Medicine 第20版,McGraw-Hill,2018
J. Loscalzo et al., Harrison's Principles of Internal Medicine, 20th ed., McGraw-Hill, 2018
独立核验依据 · Independent verification: 核验依据 2 OPENLIBRARY ISBN 标识 9781259644047（按标识回读: Harrison's prin
#老年药理学 #肾功能下降 #多重用药 #Beers标准
跌倒为什么对老年人特别危险，怎样预防？
Why are falls especially dangerous for older people, and how can they be prevented?
老年人常合并肌肉量减少、平衡与反应变慢、视力下降和骨质疏松，一次跌倒就可能造成髋部或脊柱骨折，之后的卧床、肺炎、血栓和功能丧失往往比骨折本身更致命。世界卫生组织指出跌倒是老年人伤害致死的主要原因之一。预防要多方面入手：坚持力量与平衡训练（如太极），请医生复核可能引起头晕或嗜睡的药物，矫正视力，处理体位性低血压，改造居家环境去掉门槛、地毯边缘并加装扶手和夜灯。
Older people often combine reduced muscle mass, slower balance reflexes, poorer vision and osteoporosis, so a single fall can fracture a hip or spine - and the ensuing bed rest, pneumonia, clots and loss of independence are often deadlier than the fracture itself. WHO identifies falls as a leading cause of injury death in older adults. Prevention works on several fronts: regular strength and balance training such as Tai Chi, a medication review for drugs causing dizziness or drowsiness, correcting vision, treating orthostatic hypotension, and adapting the home by removing thresholds and loose rug edges and adding grab rails and night lights.
难度 进阶 · 适合 大众
CC BY 4.0 · 来源待核验 · Source pending review
来源 · Source
出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
美国疾控中心（CDC）STEADI 老年人防跌倒项目；Tinetti ME 等《多因素干预降低老年人跌倒风险》. NEJM, 1994
CDC STEADI; Tinetti ME, et al. A multifactorial intervention to reduce the risk of falling among elderly people. N Engl J Med. 1994.
#老年跌倒 #平衡训练 #用药复核 #居家改造
医学上的老年“衰弱”（frailty）与正常衰老有什么本质区别？为什么住院或手术前要专门评估它？
What distinguishes frailty in older adults from normal aging, and why is it specifically assessed before hospitalization or surgery?
衰弱是多个生理系统储备同步下降、对应激的抵抗力显著减退的状态，并非衰老的必然结局。经典Fried标准以不明原因体重下降、自述疲乏、握力降低、步速减慢、体力活动减少五项衡量，符合三项即为衰弱。它与共病、失能彼此独立却互为因果，可预测跌倒、谵妄、住院与死亡风险；识别后可行营养运动干预并精简用药，延缓乃至部分逆转失能进程。
Frailty is a state in which reserves across multiple physiologic systems decline together, sharply reducing resilience to stressors — it is not an inevitable consequence of growing old. The classic Fried phenotype weighs five items: unintentional weight loss, self-reported exhaustion, weak grip strength, slow walking speed and low physical activity; three or more define frailty. Distinct from yet intertwined with comorbidity and disability, frailty predicts falls, delirium, hospitalization and death; recognizing it allows nutrition and exercise programs plus deprescribing to delay or partly reverse disability.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 已核验 · Verified 2026-11-03
来源 · Source
Fried, L.P. 等《老年人衰弱：一种表型的证据》，《老年学杂志A辑》（Journals of Gerontology: Series A）56卷3期，2001年，DOI:10.1093/gerona/56.3.M146
Fried, L.P. et al., “Frailty in Older Adults: Evidence for a Phenotype”, Journals of Gerontology: Series A, 56(3), 2001, DOI:10.1093/gerona/56.3.M146
独立核验依据 · Independent verification: 核验依据 1 CROSSREF 标识 10.1093/gerona/56.3.M146：Frailty in Older Ad
#老年医学 #衰弱综合征 #生理储备 #失能预防
什么是肌少症？为什么老年人要警惕肌肉量和肌力的流失？
What is sarcopenia, and why should older adults watch out for the loss of muscle mass and strength?
肌少症是随年龄增长的进行性、全身性肌肉含量减少，伴肌力和躯体功能下降。其机制包括肌肉蛋白合成的合成代谢抵抗、运动神经元退变和慢性低度炎症。肌肉衰减显著增加跌倒、骨折、失能和丧失自理能力的风险，也与病后恢复慢、死亡风险升高相关。坚持抗阻运动并保证充足膳食蛋白质，可有效延缓其进展。
Sarcopenia is a progressive, generalized loss of skeletal muscle mass with advancing age, accompanied by reduced muscle strength and physical performance. Its mechanisms include anabolic resistance of muscle protein synthesis, degeneration of motor neurons, and chronic low-grade inflammation. Losing muscle sharply increases the risks of falls, fractures, disability and dependence, and predicts slower recovery after illness and higher mortality. Regular resistance training combined with adequate dietary protein effectively slows its progression.
难度 进阶 · 适合 大众
CC BY 4.0 · 已核验 · Verified 2026-11-03
来源 · Source
Cruz-Jentoft AJ 等. 肌少症：定义与诊断的修订欧洲共识. Age and Ageing, 2019 (DOI:10.1093/ageing/afy169)
Cruz-Jentoft AJ, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing, 2019 (DOI:10.1093/ageing/afy169)
独立核验依据 · Independent verification: 核验依据 1 CROSSREF 标识 10.1093/ageing/afy169：Sarcopenia: revised Eu
#肌少症 #肌肉力量 #跌倒 #健康老龄化
为什么老年人应尽量避免长期使用苯二氮䓬类安眠药？
Why should older adults avoid long-term use of benzodiazepine sleeping pills?
老年人肝肾清除减慢，苯二氮䓬类及其活性代谢物易蓄积，半衰期延长；老年中枢神经对此类药物更敏感，易致白天镇静、注意力和记忆力下降、平衡变差，明显增加跌倒、骨折及认知损害风险。因此美国老年医学会将其列入老年潜在不适当用药清单，建议逐步减停，并以认知行为疗法等非药物手段改善失眠。
With age, slower hepatic and renal clearance lets benzodiazepines and their active metabolites accumulate, and the aging central nervous system is extra sensitive to them. Daytime sedation, impaired attention and memory, and poor balance follow, markedly raising the risks of falls, fractures and cognitive decline. Guidelines therefore class these drugs as potentially inappropriate for older adults, recommending gradual tapering and non-drug options such as cognitive behavioral therapy for insomnia.
难度 进阶 · 适合 大众
CC BY 4.0 · 已核验 · Verified 2026-11-04
来源 · Source
美国老年医学会（American Geriatrics Society）,《American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults》,Journal of the American Geriatrics Society 第71卷第7期2052-2081页,2023 (DOI: 10.1111/jgs.18372)
2023 AGS Beers Criteria Update Expert Panel, 'American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults', Journal of the American Geriatrics Society, 2023, DOI: 10.1111/jgs.18372
独立核验依据 · Independent verification: 核验依据 1 Crossref DOI 10.1111/jgs.18372
#苯二氮䓬类 #多重用药 #跌倒 #老年医学