Delirium: The 21st century health care challenge for bedside clinicians

Abstract

Delirium is a leading cause of preventable injury in hospitalized patients. Early recognition and intervention for delirium are critical to prevent morbidity and mortality, especially in the older population. Older patients are at increased risk for delirium owing to a combination of age-related changes and environmental factors. Health care providers, including nurses and physicians, often miss delirium symptoms and diagnosis in patients. Without early recognition and treatment, delirium can have significant life-changing consequences in our most vulnerable patients. This acute change in cognition can continue throughout the hospital course and may require additional rehabilitation or placement, delaying transition to home. As the baby boomers age, the older population is expected to increase, with significant implications for health care. With this in mind, the health care team, including frontline caregivers, need to be well informed about delirium. This article will expand readers' knowledge and familiarity with delirium with the purpose of improving their practice and care of the older patient. It will also address the impact of delirium and discuss tools that can help to improve recognition. The most recent advances and current treatment methods to integrate into daily patient care are also discussed. This article places heavy emphasis on identification and prevention of delirium as these are the most important aspect of understanding delirium. Thus, treatment and management are both discussed after prevention since the primary focus of delirium is understanding and preventing this devastating syndrome in our hospitalized patients.

Delirium Position Statement

“…• Offer noncaffeinated warm drinks at bedtime. • Assess routinely and medicate for pain, if needed (Burton et al, 2021;Richards et al, 2016;Todd et al, 2017).…”

“…Caution is needed for those with cardiopulmonary, renal, or hepatic disorders (Lauretani et al, 2020; Richards et al, 2016).…”

“…Delirium is often unrecognized or underdiagnosed in patients. Delirium is associated with increased lengths of stay, delayed discharge, and increased morbidity and mortality (Richards et al, 2016). Ineffective treatment of delirium can cause long-term, irreversible consequences for the hospitalized patient (Cole et al, 2015).…”

“…Hypoxia (Francis & Young, 2023; Inouye et al, 1993; Richards et al, 2016; Todd et al, 2017; Yang et al, 2017).…”

Position Statement: Delirium Among Orthopedic or Rehabilitative Patients

“…• Hypoxia (Francis & Young, 2023;Inouye et al, 1993;Richards et al, 2016;Todd et al, 2017;Yang et al, 2017) Environmental modifications. Modifications to the environment can help in the prevention and treatment of delirium.…”