Rapid Clinical Updates: Delirium and Inpatient Psychotropics-Slides

Slides

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This educational presentation by Drs. Jennifer Woodard and Babar Ali Khan, moderated by Dr. Joseph Sweigart, focuses on delirium in hospitalized older adults and the use of inpatient psychotropics. Delirium is an acute, fluctuating syndrome marked by inattention, cognitive impairment, and altered consciousness affecting 11-52% of hospitalized elders, especially post-surgical patients. It is associated with increased hospital stay, higher mortality, and greater institutionalization, but not improved long-term cognition.<br /><br />Key points include that 30-40% of delirium cases are preventable through multicomponent, non-pharmacologic interventions such as orientation, sleep protocols, early mobilization, pain control, and family involvement. Tools like the Confusion Assessment Method (CAM) and 4AT scales are effective for screening.<br /><br />Pharmacologic treatments with antipsychotics (haloperidol, quetiapine, olanzapine) do not prevent delirium or shorten its duration and carry risks including QT prolongation, drug interactions, and increased mortality in dementia patients. They should only be used short-term for severe agitation posing safety risks and not for delirium prevention. Newer agents like pimavanserin and brexpiprazole have modest efficacy for specific symptoms but are not for acute delirium management.<br /><br />Inappropriate prescribing of medications such as tramadol, benzodiazepines, and strong anticholinergics should be avoided due to delirium risk. Optimized pain management, sleep hygiene (favoring melatonin or non-benzodiazepine options), and bowel/bladder care are emphasized to reduce delirium triggers.<br /><br />Overall, delirium significantly burdens patients and healthcare systems, costing billions annually. The best evidence supports prevention through non-pharmacologic strategies rather than antipsychotics. Awareness, early recognition, etiology treatment, and supportive measures remain the mainstays for improving outcomes in elderly hospitalized patients with delirium.

Keywords

delirium

hospitalized older adults

inpatient psychotropics

non-pharmacologic interventions

Confusion Assessment Method (CAM)

antipsychotics

delirium prevention

pain management

sleep hygiene

delirium screening tools