Delirium in elderly adults: diagnosis, prevention and treatment

Fong, Tamara G.; Tulebaev, Samir; Inouye, Sharon K.

doi:10.1038/nrneurol.2009.24

Cited by 828 publications

(759 citation statements)

References 111 publications

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“…5 The presence of a severe acute disease and/or infection, abstinence or alcohol intoxication are among the factors precipitating 4 (Table 1). 6 If more predisposing factors are in an individual, the higher is its vulnerability and minor precipitating factors are required for the development of the syndrome. 5 …”

Section: Etiologymentioning

confidence: 99%

Delirium: the invisible syndrome

Gnerre¹,

Regina²,

Bozzano

et al. 2016

Ital J Med

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Delirium is a neuropsychiatric sindrome characterized by acute onset, a fluctuating course, an altered level of consciousness, disturbances in orientation, memory, attention, thinking, perception and behaviour. One third of patients aged 70 or older were admitted to the general medical service of an acute care hospital experience delirium. The development of delirium is associated with worse outcome increased a 10-fold risk for death and a 3-to 5-fold risk for nosocomial complications, prolonged length of stay, and greater need for nursing home placement after discharge. Therefore patients with delirium have higher morbidity and mortality rates, higher re-admission rates, and a greater risk of long term institutionalization care, thereby having a significant impact on both health and social care expenditure. The cost of delirium to the health-care system is then substantial. Despite its clinical importance and health-related costs, it often remains under-recognized and inadequately managed. Recent evidence suggests that a better understanding and knowledge of delirium among health care professionals can lead to early detection, the reduction of modifiable risk factors, and better management of the condition in the acute phase.

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Section: Etiologymentioning

confidence: 99%

Delirium: the invisible syndrome

Gnerre¹,

Regina²,

Bozzano

et al. 2016

Ital J Med

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“…Being slow to respond or having slower or reduced movements (Voyer et al 2006, Fong et al 2009a, NICE 2010a). …”

Section: Dementia and Deliriummentioning

confidence: 99%

Nursing care for people with delirium superimposed on dementia

Pryor

Clarke

2017

Nursing Older People

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Nursing and healthcare is changing in response to an ageing population. There is a renewed need for holistic nursing to provide clinically competent, appropriate and timely care for patients who may present with inextricably linked mental and physical health requirements.This article explores the dichotomy in healthcare provision for 'physical' and 'mental' health, and the unique role nurses have when caring for people with delirium superimposed on dementia (DSD). Delirium is prevalent in older people and recognised as 'acute brain failure'. As an acute change in cognition, it presents a unique challenge when occurring in a person with dementia and poses a significant risk of mortality. In this article, dementia is contrasted with delirium and subtypes of delirium presentation are discussed. Nurses can recognise DSD through history gathering, implementation of appropriate care and effective communication with families and the multidisciplinary team. A simple mnemonic called PINCH ME (Pain, INfection, Constipation, deHydration, Medication, Environment) can help identify potential underlying causes of DSD and considerations for care planning. The mnemonic can easily be adapted to different clinical settings is discussed with a focus on nutrition. Keywords -assessment, delirium, delirium superimposed on dementia, dementia, mental health, older peopleWith a growing older population and increasing number of people with multiple co-morbidities, the face of healthcare and healthcare provision is changing. Historically, care could be viewed as dichotomous, being split in practice and policy between that typically concerned with physical health, and that with mental health. At a global level, the World Health Organization (WHO) (2009) action plan for non-communicable diseases focuses on physical health conditions, with discrete guidance for mental health (WHO 2008). The way healthcare is delivered, explored and commissioned needs to change. In 2013, Kolappa et al called for WHO to recognise the effect of mental illness on physical health; this reflects the words of Brock Chisholm, the first director of WHO and a psychiatrist, who stated 'without mental health there can be no true physical health' (WHO 1954). Dementia and deliriumThe effect of an ageing population is becoming evident in clinical practice, as well as on individuals, their families and communities. The Alzheimer's Society (2014) predicts that there will be more than one million people in the UK living with dementia by 2025. While dementia has many subtypes and manifestations, there is consensus that it is an ongoing, clinical syndrome caused by disease or injury to the brain with usually a chronic and progressive nature Presentation of delirium falls into three main subtypes:• Hyperactive: restlessness, heightened arousal, agitation or aggression, hallucinations and hypervigilance (Voyer et al 2006, NICE 2010a).• Hypoactive: drowsiness, lethargy or sleepiness. Being slow to respond or having slower or reduced movements (Voyer et al 2006, Fong et ...

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“…The incidence of postoperative delirium in older patients is estimated between 20 and 50% [2]. Moreover, among older patients admitted to an intensive care unit (ICU), the incidence can reach 70 to 87% [1,2]. Delirium is associated with a significant increase in morbidity and mortality, a higher risk of admission to a long-term care facility and higher healthcare costs [3].…”

Section: Introductionmentioning

confidence: 99%

“…Delirium is a fluctuating syndrome characterized by inattention, altered level of consciousness and acute global cognitive impairment [1]. There are three forms of delirium, hypoactive, hyperactive and mixed forms, which fluctuate between the hyperactive and hypoactive phases [2].…”

Section: Introductionmentioning

confidence: 99%

Nursing Staff Knowledge on Postoperative Delirium in Older Inpatients: An Exploratory Survey

Mouchoux¹,

Fassier²,

Rippert³

et al. 2016

Adv Practice Nurs

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Background/Objectives: Postoperative delirium is common in the elderly and is associated with poor outcome. However, its diagnosis is often missed or delayed. Nursing staff is at the frontline and plays a crucial role in the early detection and management of delirium. This study was designed to explore the knowledge and attitudes of nursing staff about delirium in the scope of an educational program implementation. Methods:Qualitative and quantitative analyses conducted in four surgical wards and one intensive care unit in an Academic Hospital in France. A questionnaire was administered to 171 nurses and nursing assistants and semistructured interviews were conducted.Results: A total of 89 questionnaires were completed (response rate of 52%). Regarding symptoms, most of the nursing staff knew about disorientation and incoherent speech. However, few knew about acute onset and fluctuation, and the hypoactive form of delirium was virtually unknown. Regarding risk factors, while many knew about dehydration, drug use and the use of physical restraints, few knew about fecaloma, sensory impairment and infection. The staff globally knew about the main prevention measures, but knowledge on patient management was especially poor. Finally, no respondent knew about or used the Confusion Assessment Method. The qualitative analysis revealed a trivialization of delirium onset among older inpatients and the continuity of preconceived ideas on delirium, its diagnosis and its risk factors. Conclusions:On the whole, this study provides a clearer understanding of staff learning needs and identifies potential issues to be addressed in order to increase future intervention efficacy.

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Delirium in elderly adults: diagnosis, prevention and treatment

Cited by 828 publications

References 111 publications

Delirium: the invisible syndrome

Delirium: the invisible syndrome

Nursing care for people with delirium superimposed on dementia

Nursing Staff Knowledge on Postoperative Delirium in Older Inpatients: An Exploratory Survey

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