Delirium in Older Persons

7/28/2019 Delirium in Older Persons

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0 Delirium, an acute decline in attention and cognition,

is a common, life threatening, and potentially

preventable clinical syndrome among persons who

are 65 years of age or older.


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EPIDEMIOLOGY

0 In direct contrast to dementia, which is a chronic

confusional state, delirium is an acute confusional

state. Rates of delirium are highest among

hospitalized older patients, and the rates vary

depending on the patients characteristics, setting of

care, and sensitivity of the detection method. The

prevalence of delirium at hospital admission ranges

from 14 to 24 percent, and the incidence of deliriumarising during hospitalization ranges from 6 to 56

percent among general hospital populations


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DIAGNOSIS

It is a clinical diagnosis

Core feature is its impact on cognitive

function Assess all elderly people on admission

mmse may not be appropriate or

possibleUse the 4 question confusion

screening assessment.


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4 Question Screening

Assessment0Acute onset or fluctuating

course

0Inattention

0Easily distracted

0Disorganised thinking0Altered level of consciousness


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CLINICAL

CHARACTERISTICS


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Hyperactive Delirium

0Heightened arousal

0Verbally and physicallythreatening and aggressive

0Restlessness0Wandering


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Hypoactive Delirium

0 Clinical clues much less obvious

0 Apathy

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Sleepy0 Polite

0 Not interested in eating or drinking

0 Occasional incoherent speech

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Does not always understand what is said to him


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ETIOLOGIC AND RISK

FACTORS0 The cause of delirium is typically multifactorial.

0 In fact, the development of delirium involves the

complex interrelationship between a vulnerablepatient (one with predisposing factors) and exposure

to precipitating factors or noxious insults


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PATHOGENESIS

0 The pathophysiology of delirium remains poorly

understood.

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Electroencephalographic studies have demonstrateddiffuse slowing of cortical background activity, which

does not correlate with underlying causes.

0 The leading hypotheses for the pathogenesis of

delirium focus on the roles of neurotransmission,

inflammation, and chronic stress.


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DEMENTIA VS DELIRIUM

0Dementia has an insidious onset, chronicmemory and executive function disturbance,

tends not to fluctuate. In delirium cognitivechanges develop acutely and fluctuate.

0Dementia has intact alertness and attentionbut impoverished speech and thinking. In

delirium speech can be confused ordisorganized. Alertness and attention wax andwane.


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PREVENTION AND

MANAGEMENT


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SUMMARY

0 Delirium is a common presentation of acute illness in

older people

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The presence of delirium is associated with adverseoutcome

0 Characterised by recent onset fluctuating inattention

and drowsiness linked to triggering factors

Documents

Delirium in Older Persons