Delirium
Prevention
Regarding prevention, the aim should be to minimize exposure to the various patient- and hospital-related factors that are known to predispose to delirium in elderly inpatients. The ward environment and routines should aim to avoid unnecessary sensory impairment and sleep deprivation, and support a normal sleep-wake cycle. Nonpharmacological sleep-promotion strategies should be used in preference to hypnotic drugs. It is important to ensure adequate food and fluid intake, and patients should be encouraged to be mobile whenever possible. Careful prescribing is important, avoiding where possible any drugs with known potential to cause delirium, particularly in at-risk individuals such as those with dementia. The drug chart should be regularly reviewed, with the aim of keeping the burden of medication as low as possible. In surgical patients, good pre-, peri-, and postoperative care (especially with regard to blood pressure, oxygenation, pain relief, and infection control) will reduce the risk of postoperative delirium.
JAMES LINDESAY
See also DEMENTIA; DISEASE PRESENTATION; PSYCHIATRIC DISEASE IN RELATION TO PHYSICAL ILLNESS; SURGERY IN ELDERLY PEOPLE.
BIBLIOGRAPHY
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association, 1994.
American Psychiatric Association. Practice Guideline for the Treatment of Patients with Delirium. Washington, D.C.: American Psychiatric Association, 1999.
BYRNE, E. J. Confusional States in Older People. London: Edward Arnold, 1994.
CARLSON, A.; GOTTFRIES, C.; WINBLAD, B.; and ROBERTSSON, B., eds. "Delirium in the Elderly: Epidemiological, Pathogenetic, Diagnostic and Treatment Aspects." Dementia and Geriatric Cognitive Disorders 10 (1999): 305–430.
FRANCIS, J., and KAPOOR, W. N. "Prognosis after Hospital Discharge of Older Medical Patients with Delirium." Journal of the American Geriatrics Society 40 (1992): 601–606.
INOUYE, S. K., and CHARPENTIER, P. A. "Precipitating Factors for Delirium in Hospitalized Elderly Persons. Predictive Model and Interrelationship with Baseline Vulnerability." Journal of the American Medical Association 275 (1996): 852–857.
LEVKOFF, S.; EVANS, D.; LIPTZIN, B.; et al. "Delirium, the Occurrence and Persistence of Symptoms among Elderly Hospitalised Patients." Archives of Internal Medicine 152 (1992): 334–340.
LINDESAY, J.; MACDONALD, A.; and STARKE, I. Delirium in the Elderly. Oxford: Oxford University Press, 1990.
LIPOWSKI, Z. J. Delirium: Acute Confusional States. New York: Oxford University Press, 1990.
ROCKWOOD, K.; COSWAY, S.; CARVER, D.; et al. "The Risk of Dementia and Death Following Delirium." Age and Ageing 28 (1999): 551–556.
RUDBERG, M. A.; POMPEI, P.; FOREMAN, M. D.; ROSS, R. E.; and CASSEL, C. K. "The Natural History of Delirium in Older Hospitalized Patients: A Syndrome of Heterogeneity." Age and Ageing 26 (1997): 169–174.
Additional topics
Medicine EncyclopediaAging Healthy - Part 1Delirium - Age And Delirium, Causes, Outcome, Clinical Management, Prevention