Diagnosing and managing delirium in the elderly (original) (raw)
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Treatment of Delirium in Older Persons: What We Should Not Do!
International Journal of Molecular Sciences, 2020
The presentation of common acute diseases in older age is often referred to as “atypical”. Frequently, the symptoms are neither single nor tissue related. In most cases, the onset of symptoms and diseases is the expression of a diminished reserve with a failure of the body system and imbalance of brain function. Delirium is one of the main devastating and prevalent atypical symptoms and could be considered as a geriatric syndrome. It encompasses an array of neuropsychiatric symptoms and represents a disarrangement of the cerebral function in response to one or more stressors. The most recent definition, reported in the DSM-V, depicts delirium as a clear disturbance in attention and awareness. The deficit is to be developed in a relatively short time period (usually hours or days). The attention disorder must be associated with another cognitive impairment in memory, orientation, language, visual-spatial or perception abilities. For the treatment, it is imperative to remove the poten...
Methods of care and non-pharmacological treatment of delirium in elderly patients
MOJ Gerontology & Geriatrics, 2019
The occurrence of delirium in the elderly population is an indication for rapid implementation of adequate treatment. The treatment itself is not focused on administering drugs, but depends on all available knowledge about the patient such as the patient’s medical history, living conditions or communication skills. Delirium is usually a result of the overlapping predispositioning and triggering factors. Prevention is based on eliminating or mitigating the conditions promoting this clinical syndrome. Non-pharmacological treatment includes: avoiding orthostatic and postprandial hypotension, maintaining physical fitness, monitoring mood disorders, especially depressive syndrome and improving cognitive functions. It is crucial to determine and address these factors among patients. Proper, relevant actions need to be implemented. This basic knowledge and appropriate involvement of caregivers (both formal and informal) are necessary to reduce the frequency, duration and severity of deliri...
Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments
Dementia & neuropsychologia
Delirium is a common disorder associated with poor prognosis, especially in the elderly. The impact of different treatment approaches for delirium on morbimortality and long-term welfare is not completely understood. To determine the efficacy of pharmacological and non-pharmacological treatments in elderly patients with delirium. This systematic review compared pharmacological and non-pharmacological treatments in patients over 60 years old with delirium. Databases used were: MEDLINE (PubMed), EMBASE, Cochrane CENTRAL and LILACS from inception to January 6th, 2016. A total of ten articles were selected. The six non-pharmacological intervention studies showed no impact on duration of delirium, mortality or institutionalization, but a decrease in severity of delirium and improvement in medium-term cognitive function were observed. The most commonly used interventions were temporal-spatial orientation, orientation to self and others, early mobilization and sleep hygiene. The four studi...
Symptoms and aetiology of delirium: a comparison of elderly and adult patients
East Asian Archives of Psychiatry 2013; 23:56-64
Objective: To compare the symptoms of delirium as assessed by the Delirium Rating Scale–Revised-98 (DRS-R-98) and associated aetiologies in adult and elderly patients seen in a consultation-liaison service. Methods: A total of 321 consecutive patients with a DSM-IV-TR diagnosis of delirium were assessed on the DRS-R-98 and a study-specific aetiology checklist. Results: Of the 321 patients, 245 (76%) aged 18 to 64 years formed the adult group, while 76 (24%) formed the elderly group (≥ 65 years). The prevalence and severity of various symptoms of delirium as assessed using the DRS-R-98 were similar across the 2 groups, except for the adult group having statistically higher prevalence and severity scores for thought process abnormalities and lability of affect. For both groups and the whole sample, factor analysis yielded a 3-factor model for the phenomenology. In the 2 groups, the DRS-R-98 item loadings showed subtle differences across various factors. The 2 groups were similar for the mean number of aetiologies associated with delirium, the mean number being 3. However, the 2 groups differed with respect to hepatic derangement, substance intoxication, withdrawal, and postpartum causes being more common in the adult group, in contrast lung disease and cardiac abnormalities were more common in the elderly group. Conclusion: Adult and elderly patients with delirium are similar with respect to the distribution of various symptoms, motor subtypes, and associated aetiologies.
DELIRIUM IN THE ELDERLY: EARLY IDENTIFICATION, TREATMENT AND INTERDISCIPLINARY APPROACH (Atena Editora), 2024
Delirium, according to DSM-5, is a syndrome characterized by a disturbance in attention and consciousness, which develops rapidly and is associated with underlying medical conditions, intoxication or withdrawal. Risk factors include preexisting neuropathologies, polypharmacy, infections, dehydration, immobility, hospitalizations, malnutrition, use of indwelling catheters, and advanced age. The integrative review, covering articles from 2014 to 2024 in Portuguese and English, was carried out in June 2024 through platforms such as PubMed, UpToDate and Google Scholar. Delirium in the elderly leads to prolonged hospitalizations, functional and cognitive decline, and increased mortality. Early identification and treatment are crucial to prevent complications. An interdisciplinary approach includes the management of psychomotor changes, pain control, adequate nutrition, improvement of mobility, prevention of skin lesions and pharmacological treatment when necessary. Non-pharmacological strategies such as normalizing the circadian rhythm and cognitive stimulation are essential for recovery.
Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients
Archives of Internal Medicine, 1992
We evaluated the occurrence and persistence of delirium in 325 elderly patients admitted to a teaching hospital from either a defined community or a long-term care facility. Of the study participants, 34 (10.5%) had Diagnostic and Statistical Manual of Mental Disorders, Third Edition-defined delirium at initial evaluation; of the remaining patients, 91 (31.3%) developed new-onset delirium. An additional 110 patients also experienced individual symptoms of delirium without meeting full criteria. Preexisting cognitive impairment and advanced age were associated with increased risk of incident delirium in the community sample but not the institutional one. Delirium was not associated with an increased risk of mortality, but it was associated with a prolonged hospital stay and an increased risk of institutional placement among community-dwelling elderly. Only five patients (4%) experienced resolution of all new symptoms of delirium before hospital discharge, and only 20.8% and 17.7%, respectively, had resolution of all new symptoms by 3 and 6 months after hospital discharge. These data suggest that delirium is a common disorder that may be substantially less transient than currently believed and that incomplete manifestations of the syndrome may be frequent. (Arch Intern Med. 1992;152:334-340) Delirium is commonly defined as a transient organic brain syndrome characterized by concurrent disor¬ ders of attention, perception, thinking, memory, psychomotor behavior, and the sleep-wake cycle.1-2 Previous studies, despite substantial variation in methods and ter-minology, suggest that deUrium is common. Estimates of delirium among elderly persons on hospital admission to general medical settings have varied from 15% to 24%,3"9 and reported rates of new-onset or incident delirium have ranged from 5% to 35%.7"10 Despite its high frequency, delirium is often overlooked in routine clinical prac¬ tice.1-211 The early recognition of any reversible causes is important because the failure to treat underlying disease adequately can result in increased morbidity and mortal¬ ity as well as longer hospital stays.1-2-11-12
Delirium in Elderly People: A Review
Frontiers in Neurology, 2012
The present review aims to highlight this intricate syndrome, regarding diagnosis, pathophysiology, etiology, prevention, and management in elderly people. The diagnosis of delirium is based on clinical observations, cognitive assessment, physical, and neurological examination. Clinically, delirium occurs in hyperactive, hypoactive, or mixed forms, based on psychomotor behavior. As an acute confusional state, it is characterized by a rapid onset of symptoms, fluctuating course and an altered level of consciousness, global disturbance of cognition or perceptual abnormalities, and evidence of a physical cause. Although pathophysiological mechanisms of delirium remain unclear, current evidence suggests that disruption of neurotransmission, inflammation, or acute stress responses might all contribute to the development of this ailment. It usually occurs as a result of a complex interaction of multiple risk factors, such as cognitive impairment/dementia and current medical or surgical disorder. Despite all of the above, delirium is frequently under-recognized and often misdiagnosed by health professionals. In particular, this happens due to its fluctuating nature, its overlap with dementia and the scarcity of routine formal cognitive assessment in general hospitals. It is also associated with multiple adverse outcomes that have been well documented, such as increased hospital stay, function/cognitive decline, institutionalization and mortality. In this context, the early identification of delirium is essential. Timely and optimal management of people with delirium should be performed with identification of any possible underlying causes, dealing with a suitable care environment and improving education of health professionals. All these can be important factors, which contribute to a decrease in adverse outcomes associated with delirium.
Management of Delirium in Elderly Patients
2021
Delirium was described in the first century AD by Celsus as “mental disorders such as hysteria, depression or mania, during fever or head trauma”. The word delirium comes from the Latin de away from and lira furrow, meaning ‘the plough is out of the furrow’ or in more modern terms, ‘the train is off the track’. An even earlier description of a disorder with these features was known to Hippocrates as phrenitis and occurred in febrile patients. Delirium can be defined as a transient, reversible syndrome that is acute and fluctuating, and which occurs in the setting of a medical condition. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders defines delirium as a disturbance of consciousness and cognition that develops over a short period of time and fluctuates over time.
Delirium in hospitalised older persons: review
The Journal of Nutrition Health Aging, 2008
Delirium, a mental disorder that becomes established over a few hours or days, is characterised by fluctuating attention and cognitive states. This article reviews the disorder, which has all the features of an important geriatric syndrome: it appears mainly in persons older than 65 years of age, is closely linked with very prevalent diseases and complications arising in the elderly, and is the mode of presentation of many other diseases in this age group. We discuss diagnostic, clinical preventive and therapeutic aspects and analyse the most common risk and precipitating factors in our hospitalised patients from the viewpoint of clinical practice. Finally, we propose a scheme for the prevention and treatment of delirium.