老年失眠与抑郁、焦虑共病诊疗专家共识OA
Expert consensus on the diagnosis and treatment of comorbid insomnia,depression,and anxiety in older adults
失眠与抑郁、焦虑在老年人中常同时存在并相互促进,且受认知改变、躯体疾病、多重用药及社会心理因素共同影响.若仅处理单一症状,容易导致漏诊、疗效不佳和药物相关不良事件发生.失眠叠加抑郁、焦虑还与痴呆风险升高相关,部分患者的睡眠和情绪改变可能是神经退行性疾病的早期线索.本共识聚焦60 岁及以上人群的失眠与抑郁、焦虑共病,提出"睡眠、情绪、认知三维评估—共病诊断—协同干预—动态随访"的临床路径.诊疗重点是确认共病,识别起病先后、共同病因和相互影响因素,确定主要治疗靶点,协调睡眠与情绪干预,并控制联合用药的镇静、跌倒及认知风险.中医药可在规范诊断和安全评估的基础上辨证联合应用.对符合痴呆前心理行为障碍诊断标准者,应转入认知障碍病因诊断与治疗.本共识不替代单病种专病指南,旨在为临床医师提供聚焦共病诊断与协同治疗的实践参考.
Insomnia,depression,and anxiety commonly coexist and interact in older adults,influenced by cognitive decline,physical illness,polypharmacy,and psychosocial factors.Treating a single symptom may lead to missed diagnoses,poor outcomes,and medication-related harms.Their coexistence is also associated with increased dementia risk,and sleep or mood changes may signal early neurodegeneration.This consensus addresses adults aged≥60 years and recommends a clinical pathway of three-dimensional assessment of sleep,mood,and cognition;comorbidity diagnosis;coordinated treatment;and dynamic follow-up.Key priorities are identifying onset patterns,shared causes,treatment targets,and risks associated with combined therapy,particularly sedation,falls,and cognitive impairment.Traditional Chinese medicine may be used adjunctively after standardized diagnostic and safety assessments.Patients meeting criteria for pre-dementia psychological and behavioral disorders should undergo etiological evaluation for cognitive impairment.This consensus complements,but does not replace,disease-specific guidelines.
上海市医师协会老年医学科医师分会;国家重点研发计划主动健康和人口老龄化科技应对重点专项专家组;李霞;保志军
老年人失眠障碍抑郁障碍焦虑障碍共病综合评估与干预
older adultsinsomnia disorderdepressive disorderanxiety disordercomorbiditycomprehensive assessment and intervention
《老年医学与保健》 2026 (4)
499-504,6
国家重点研发计划(2023YFC3603200)
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