Occurrence and outcome of delirium in medical in-patients: a systematic literature review

Abstract

Delirium is common in medical in-patients and has serious adverse effects on mortality, functional outcomes, LOS and institutionalisation. The development of appropriate strategies to improve its management should be a clinical and research priority. As delirium prevalent at hospital admission is a significant problem, research is also needed into preventative measures that could be applied in community settings.

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

“…1,2 In patients admitted to hospital, around 30-40% of delirium cases are thought to be attributable to modifi able risk factors, and are therefore preventable. 3 Various approaches aimed at minimising the infl uence of risk factors in medical patients have not improved outcomes, and there are no conclusive studies that support pharmacological prophylaxis. 4 Dexmedetomidine is a highly selective α 2 adrenoreceptor agonist that provides anxiolysis, sedation, and modest analgesia with minimal respiratory depression.…”

Ten ways to improve the care of elderly patients in the hospital

“…38,39 Delirium predicts longer hospital stay, increases likelihood of discharge to a skilled nursing facility, and is a marker for significant morbidity and mortality. [40][41][42] Cognitive screening, as discussed above, can help determine who is at risk for delirium, and the Confusion Assessment Method (CAM) is becoming more widely used as a bedside screening tool for detecting delirium.…”

Whether Delirium Acts as ECT?

“…Since delirium is an acute medical condition, its prevalence can only be studied in hospital settings. A meta-analysis of 42 studies found delirium to be prevalent on admission in 10-31% of medical inpatients, and to occur in the hospital in 3-29% [4]. Fong et al [5] reported that the overall prevalence of delirium in the community is just 1-2%, but in the setting of general hospital admission this increases to 14-24%.…”

“…Fong et al [5] reported that the overall prevalence of delirium in the community is just 1-2%, but in the setting of general hospital admission this increases to 14-24%. The incidence of delirium arising during a hospital stay ranges from 6% to as high as 56%, and this incidence is even higher when more-specialized populations are considered, including those in postoperative, intensive-care, subacute and palliative-care settings [4,6,7]. Postoperative delirium occurs in 15-53% of surgical patients over the age of 65 years [8] and among elderly patients admitted to an Intensive Care Unit (ICU) the delirium incidence can reach 70-87% [9].…”