Recent publications of data on the trajectories of depressive symptoms prompted the authors to consider the advisability of widening the debate on the possibilities of setting and recording 'general, overall trajectories of life'. The authors set themselves the goal of formulating the outline of a method for determining the overall trajectory of life and ways of presenting such a data set. The authors argue that if the trajectory of life concerns aspects related to the estimation of health, then the most concise and useful way of its presentation is to formulate the so-called 'Sequence of adverse life events' that led to the illness or health disaster. The authors cite an example of such a record. They also emphasize that considering the general trajectory of life requires not only the use of methods arising from neural sciences (autobiographic memory) and various schools of psychology, but that it is very useful to refer to distinguished literary (cultural) works.
The processes of ageing and the related impairment of maintaining homeostasis, understood as the loss of adaptive abilities, lead to an increased susceptibility to developing delirium among the elderly. The pathophysiological process of delirium development is dependent on the presence of causative and predisposing factors; for example, neurotransmission process disorders (cholinergic, serotonin and dopaminergic regulation), resulting in metabolic inefficiency of the brain. The symptoms of delirium differ in duration and severity; there are 3 clinical subtypes of delirium: hypoactive, hyperactive and mixed. Moreover, subsequent evaluations using methodological tools have made it possible to distinguish an additional subtype of delirium -the no-motor subtype. Recognizing the delirium subtype is essential -it identifies high-risk patients, has an effect on the procedures, treatment and further prognosis. Medical personnel working with elderly patients ought to be well familiar with the predisposing factors, non-pharmacological procedures, treatment and prognosis of delirium; they also are required to know how to differentiate between each delirium subtype. Physicians should be aware that the hypoactive subtype of delirium indicates a much worse prognosis for patients.
The occurrence of delirium in the elderly population is an indication for rapid implementation of adequate treatment. The treatment itself is not focused on administering drugs, but depends on all available knowledge about the patient such as the patient’s medical history, living conditions or communication skills. Delirium is usually a result of the overlapping predispositioning and triggering factors. Prevention is based on eliminating or mitigating the conditions promoting this clinical syndrome. Non-pharmacological treatment includes: avoiding orthostatic and postprandial hypotension, maintaining physical fitness, monitoring mood disorders, especially depressive syndrome and improving cognitive functions. It is crucial to determine and address these factors among patients. Proper, relevant actions need to be implemented. This basic knowledge and appropriate involvement of caregivers (both formal and informal) are necessary to reduce the frequency, duration and severity of delirium, which develops in observed patients. Non-medical caregivers are advised to follow the rules formulated by geriatrists of proceeding with patients in order to minimize the risk of developing delirium.
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