3 Ds - Delirium, dementia, depression Flashcards
delirium - features
worsening confusion
rapid onset and fluctuant
altered consciousness (alert/aware), disordered thinking
secondary cause
other: emotions, behaviours, hypo/hyperactive, perception changes
hypo 40%, hyper 25%, mixed 35%
delirium - RF/triggers
RF: dementia, frail, age, co-morbidities, sensory impairment
triggers: drugs/substances, infection, surgery, brain disease, hypoxia, metabolic
delirium - assessment approach
history and collateral
exam: obs, sepsis, MSK, neuro, sensory, PR
investigations
delirium - aetiology
‘DELIRIUM’: drugs, electrolytes, lack of drugs, infection, reduced senses, intracranial, urinary retention, myocardial
also: trauma, hypoxia, vascular, toxins/heavy metals, sleep, anx/depp
delirium - prognosis
increased mortality (2x; 1y 40%) longer Ax + institutionalisation ^complications 3x dementia risk (?herald/trigger) reduced function/incomplete recovery
delirium - epidemiology
20% IP prevalence, 1-2% GP; 50% have dementia (5-10x risk); 67% of dementia IP
AMU 10%, post-op 15%, stroke 25%, HCOP 30%, post-op hip 50%, ITU 60%, palliative 80%
often under-recognised and under-Dx: always consider!!
delirium - management
1) ID and treat cause
2) manage Sx: enviro, pain, hydration, nutrition
3) prevent complications: falls, infections, pressure, incontinence, meds, nutrition, fx decline
4) explanations: patient/family
environment: calm, familiar, orientating, big signs
treatment: reassure safety, minimally invasive (no lines), rehydrate, nutrition, bowels, meds, mobility, senses
delirium - DDx
dementia: chronic, general function and IQ
psychiatric: psychosis (e.g. schizophrenia or depression)
depression - epidemiology
commonest mental disorder in elderly
affects 30% community, 15-20% clinically depressed
1 in 6 don’t discuss Sx with GP
1 in 5 GP attendees have psychological symptoms
1 in 20 are likely to respond to ADD
23% of RH, 30-35% of NH, 29% acute med IP, 40-45% post-stroke
85% also have anxiety
25% of suicides are elderly
10-20% have delirium
depression - features
more severe baseline illness,
more likely to have psychosis (incl. paranoia), anxiety, and somatisation
more psychosocial impairment (incl. agitation), sleep issues, appetite/weight
increased risk of chronic illness
poorer, slower treatment response
increased suicide risk
pseudo-dementia and delirium DDx; ‘masked depression’
depression - suicide features
more successful: 1in4 success (vs. 1in15-20)
more commonly felt, less commonly expressed
check risk before prescribing ADD
RF: male, bereaved, alone/isolated, pain/physical illness, alcohol, depressed, GP
depression - management
bio: ADD (SSRIs), comorbidities, med r/v
psycho: education + CBT/IAPT
social: usuals; carer support (e.g. respite), diet and exercise, groups
depression - history
HPC: onset, Sx, triggers/RF, coping mechs
alcohol/substance
risk/insight; SI
depression - RF/triggers
triggers: life events; health; stress; somatisation
risk factors: PMH/FH; poor physical health, or loss of health/mobility; poverty, or institutionalised; widow/er, alone/isolate, poor social support/no confidant; personality; recent loss/bereavement, retirement; some medications
depression - HCE differences
settings: home/OPD/CH/IP memory/MCI: collaterals comorbidities + polypharma (MH risk) perspective: significance and attribution suicide risk high: more successful
white matter hyperintensity, vascular depression
