COVID-19 and Agitated Patients with Dementia in Family Medicine Clinics

Udio starijih osoba u našoj općoj populaciji prema izvješću Državnog zavoda za statistiku iznosi preko 20 %. Mentalno zdravlje starijih osoba postaje zato sve značajniji problem jer se većina starijih osoba zbrinjava u kućnim uvjetima i pod stalnom su skrbi liječnika obiteljske medicine. Pojavom pandemije COVID-19, ali i snažnim potresom u Zagrebu i okolici, nastupile su značajne promjene u životima osoba starije životne dobi, pa i u osoba koje im pružaju pomoć i skrb. Ograničavanje kretanja smanjilo je kvalitetu brige oko starijih osoba te su se počeli učestalije događati problemi vezani za uznemirenost, promjenu ponašanja i pojavu delirantnih stanja kod osoba s demencijom, ali i kod osoba starije životne dobi koje su do tada normalno kognitivno funkcionirale. Uzroci ovim stanjima mogu varirati od okolišnih promjena, pojave tjelesnih poremećaja, dehidracije, metaboličkih disbalansa do pogoršanja povezanih s demencijom. Ovisno o uzrocima pojave uznemirenosti, u zbrinjavanju bolesnika prije primjene lijekova treba pokušati s nefarmakološkim metodama koje ponekad mogu biti vrlo učinkovite. Od farmakoloških mjera primjenjuju se lijekovi iz dvije skupine psihofarmaka: benzodiazepini i antipsihotici. Hrvatska klinička praksa djelomično se razlikuje od prakse drugih država jer nam nisu dostupni svi lijekovi za kontrolu uznemirenosti. Primjerice, na našem tržištu nemamo parenteralni lorazepam, a imamo diazepam i midazolam za parenteralnu primjenu, koji ipak nisu za preporučiti u starijih osoba. Od antipsihotika ne koristimo sve koji su nam dostupni, npr. gotovo uopće ne koristimo intramuskularni olanzapin i ziprasidon. S druge strane, koristimo parenteralni promazin koji se ne koristi u drugim zemljama. U uvjetima obiteljske medicine najbolje je pokušati zbrinjavanje u kući s peroralnim lijekovima u malim podijeljenim dozama, uz edukaciju njegovatelja kako procijeniti stanje i koju metodu zbrinjavanja primijeniti. Na kraju donosimo preporuke lijekova i doza za zbrinjavanje uznemirenosti u osoba s dementnim sindromom.The share of the elderly in our general population, according to the report of the Central Bureau of Statistics, is over 20%. Geriatric mental health is therefore becoming an increasingly significant problem, as most elderly people live at home and are under the continuous care of general physicians. With the emergence of the COVID-19 pandemic, topped with the destructive earthquake that hit the greater Zagreb area, significant changes occurred in the lives of the elderly, as well as with those who provide them with help and care. Restriction of movement reduced the quality of geriatric care, and caused a rise in anxiety-related problems, behavioral change, and the occurrence of delirium in people with dementia, but also in the elderly who had been functioning normally until then. The causes of these conditions can vary from environmental changes, development of physical disorders, dehydration, metabolic disbalances, and deterioration associated with dementia. Depending on the sources of agitation, before the administration of medication, non-pharmacological methods should be tried, as such treatment may often be very effective. Pharmacological treatment includes two classes of drugs: benzodiazepines and antipsychotics. Croatian clinical practice differs in part from the practice of other countries due to the fact that some drugs are not available to us. For example, we do not have parenteral lorazepam on our market, but we do have diazepam and midazolam for parenteral administration, which, however, are not recommended in the elderly. Furthermore, we do not use all the antipsychotics that are available to us. For instance, we rarely use intramuscular olanzapine and ziprasidone, but we do use parenteral promazine, which is not used in other countries. Within the framework of family medicine, it is best to try home care with oral medications in small divided doses, along with the education of caregivers, on how to assess the condition and which method of care to apply. The article presents a list of recommended drugs and doses for the management of anxiety in people with demetia