Early Intervention for Delirium

Meagher, David; Cullen, William R.

doi:10.1002/9781118557174.ch19

Cited by 4 publications

(3 citation statements)

References 109 publications

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“…Pre-existing dementia is a well-recognised risk factor for delirium, but more subtle impairments of attention, vigilance, memory, visuospatial function, graphomotor speed and executive function25 are also linked to elevated delirium risk. A key challenge is to apply this evidence to identifying a neuropsychological profile that reliably predicts delirium risk and that can be applied along with other clinical predictors to routine screening in real-world settings and linked to remedial/preventative interventions especially in those who are at high risk or facing periods of elevated risk due to elective interventions.…”

Section: Bench: Unravelling the Psychobiology Of Deliriummentioning

confidence: 99%

“…Early detection of delirium can allow for more timely and effective intervention while non-detection is associated with poorer outcomes that include elevated mortality 11. Poorer detection rates occur with hypoactive presentations, cases complicated by comorbid dementia, and in patients with a history of previous psychiatric problems, prominent pain or receiving care in surgical settings 25. Importantly, these features also characterise patients with the poorest outcomes.…”

Section: Delirium At the Bedsidementioning

confidence: 99%

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Improving delirium care through early intervention: from bench to bedside to boardroom

O’Hanlon

O’Regan

MacLullich

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

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Delirium is a complex neuropsychiatric syndrome that impacts adversely upon patient outcomes and healthcare outcomes. Delirium occurs in approximately one in five hospitalised patients and is especially common in the elderly and patients who are highly morbid and/or have pre-existing cognitive impairment. However, efforts to improve management of delirium are hindered by gaps in our knowledge and issues that reflect a disparity between existing knowledge and real-world practice. This review focuses on evidence that can assist in prevention, earlier detection and more timely and effective pharmacological and non-pharmacological management of emergent cases and their aftermath. It points towards a new approach to delirium care, encompassing laboratory and clinical aspects and health services realignment supported by health managers prioritising delirium on the healthcare change agenda. Key areas for future research and service organisation are outlined in a plan for improved delirium care across the range of healthcare settings and patient populations in which it occurs.

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Section: Bench: Unravelling the Psychobiology Of Deliriummentioning

confidence: 99%

Section: Delirium At the Bedsidementioning

confidence: 99%

Improving delirium care through early intervention: from bench to bedside to boardroom

O’Hanlon

O’Regan

MacLullich

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

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“…Common bedside cognitive tests have been suggested for screening; however, they often lack specificity for delirium (Meagher and Cullen, ) unless they test domains (e.g. attention) disproportionately affected in delirium when compared to normal ageing and dementia (O'Keeffe and Gosney, ; O'Regan et al ., ; Pompei et al ., ; Tieges et al ., ).…”

Section: Introductionmentioning

confidence: 99%

Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups

O’Regan

Maughan

Liddy

et al. 2016

Int J Geriat Psychiatry

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Caring for critically ill patients with a mental illness: A discursive paper providing an overview and case exploration of the delivery of intensive care to people with psychiatric comorbidity

Flaws,

Patterson,

Bagshaw

et al. 2023

Nursing Open

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AimTo address the need for additional education in the management of mental illness in the critical care setting by providing a broad overview of the interrelationship between critical illness and mental illness. The paper also offers practical advice to support critical care staff in managing patients with mental illness in critical care by discussing two hypothetical case scenarios involving aggressive and disorganised behaviour.People living with mental illness are over‐represented among critically unwell patients and experience worse outcomes, contributing to a life expectancy up to 30 years shorter than their peers. Strategic documents call for these inequitable outcomes to be addressed. Staff working in intensive care units (ICUs) possess advanced knowledge and specialist skills in managing critical illness but have reported limited confidence in managing patients with comorbid mental illness.Design & MethodsA discursive paper, drawing on clinical experience and research of the authors and current literature.ResultsLike all people, patients with mental illnesses draw on their cognitive, behavioural, social and spiritual resources to cope with their experiences during critical illness. However, they may have fewer resources available due to co‐morbid mental illness, a history of trauma and social disadvantage.By identifying and sensitively addressing patients' underlying needs in a trauma‐informed way, demonstrating respect and maximising patient autonomy, staff can reduce distress and disruptive behaviours and promote recovery.Caring for patients who are distressed and/or display challenging behaviours can evoke strong and unpleasant emotional responses. Self‐care is fundamental to maintaining a compassionate approach and effective clinical judgement. Staff should be enabled to accept and acknowledge emotional responses and access support—informally with peers and/or through formal mechanisms as needed. Organisational leadership and endorsement of the principles of equitable care are critical to creation of the environment needed to improve outcomes for staff and patients.Relevance to clinical practiceICU nurses hold an important role in the care of patients with critical illnesses and are ideally placed to empower, advocate for and comfort those patients also living with mental illness. To perform these tasks optimally and sustainably, health services have a responsibility to provide nursing staff with adequate education and training in the management of mental illnesses, and sufficient formal and informal support to maintain their own well‐being while providing this care.Patient and public involvementThis paper is grounded in accounts of patients with mental illness and clinicians providing care to patients with mental illness in critical care settings but there was no direct patient or public contribution.

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Early Intervention for Delirium

Cited by 4 publications

References 109 publications

Improving delirium care through early intervention: from bench to bedside to boardroom

Improving delirium care through early intervention: from bench to bedside to boardroom

Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups

Caring for critically ill patients with a mental illness: A discursive paper providing an overview and case exploration of the delivery of intensive care to people with psychiatric comorbidity

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