SHM's Clinical Quick Talks-Delirium

Pdf Summary
Delirium is a disorder that develops acutely and alters awareness and attention. It can present in two main ways: hyperactive delirium, characterized by agitation, and hypoactive delirium, characterized by apathy and withdrawal. Delirium can occur in anyone who is acutely sick or hospitalized, but it is particularly common in the elderly. It is estimated that about one-third of patients aged 70 or older experience delirium when admitted to the hospital, and about 15% of new admissions to skilled nursing facilities meet the criteria for delirium.<br /><br />Delirium is associated with poorer outcomes, including increased risk of death, institutionalization, and dementia, especially when it persists for weeks to months after discharge from the hospital. There are two proposed mechanisms for the development of delirium: cholinergic deficiency and inflammation. Risk factors for delirium include age, medications, surgery, sensory impairment, pain, dementia, and multiple medical conditions.<br /><br />It is important to differentiate delirium from other conditions such as dementia, depression, and acute psychiatric syndrome, as they can coexist. The history should focus on the timeline and precipitating factors, as well as conducting a thorough medication review. Physical examination and diagnostic studies, such as lab tests and imaging, may also be performed to assess the patient.<br /><br />The Confusion Assessment Method (CAM) is commonly used to assess the severity of delirium. Non-pharmacological measures, such as providing orientation and creating a safe environment, are often more effective than pharmacological interventions. However, if medication is necessary, antipsychotics may be used, although the risk and benefits should be carefully considered.<br /><br />In conclusion, delirium is a common and serious condition that can occur in acutely sick or hospitalized individuals, particularly the elderly. It is important to accurately diagnose and manage delirium to prevent adverse outcomes. Non-pharmacological interventions should be considered first, and if medication is necessary, it should be used cautiously, taking into account the individual patient's situation.
Asset Subtitle
Himabindu Lanka
Keywords
delirium
disorder
awareness
attention
elderly
outcomes
risk factors
dementia
Confusion Assessment Method
pharmacological interventions