Ageing: Confusion Flashcards
What are 4 risk factors for delirium?
- Age > 65
- Cognitive impairment and/or dementia
- Current hip fracture
- Severe illness
If an individual with delirium becomes distressed, and verbal/non-verbal de-escalation techniques are ineffective, what medication would you administer?
0.5mg PO or 1mg IM Haloperidol (max 2mg/24h)
(given short-term; ≤ 1wk)
or Olazapine
In which 2 conditions is it inappropriate to give someone haloperidol for delirium?
- PD
2. Lewy Body Dementia
What are the 5 principles of the Mental Capacity Act?
- Capacity is assumed
- People should be helped to be able to decide
- People are allowed to be unwise
- Treat people in their best interest
- Use the least restrictive option
What screening tool can be used bedside to determine someone’s cognition?
AMTS 10 (or a shorter version called AMT 4)
What questions are asked in the AMT 4 mental test?
- Patient name
- Patient DOB
- Where they are
- Today’s date
List 10 things that can lead to delirium in an elderly patient?
- Recent surgery
- Poor sleep
- Pain
- Previous delirium
- Constipation
- Environment
- Dehydration
- Infection
- Hip Fracture
- Drugs
What is delirium?
Acute onset confusion with a change in alertness (i.e. agitated, hyper-alert)
What are the 2 validated tools that can be used to diagnose delirium?
- 4AT
- CAM (confusion assessment method)
- Should be performed at every consultation with this patient to monitor changes
What does it mean to be Confusion Assessment Method (CAM) positive?
A patient must have 1 + 2 + 3 or 4:
- Acute onset + fluctuating course
- Inattention
- Disorganized thinking
- Altered level of consciousness
What are the 4 components to the 4 AT assessment method?
- Alertness
- AMT 4 (age, DOB, current location, current date)
- Attention (name months backwards from Dec)
- Acute/fluctuating course
4+ = possible delirium +/- cognitive impairment 1-3 = possible cognitive impairment 0 = delirium or cognitive impairment unlikely
What are 6 general measures that should be taken for all patients with delirium?
- Reassurance + re-orientation in calm environment, promoting normal sleep pattern
- Increase nursing observation
- Encourage mobility
- Increase oral intake
- Regular monitoring of AMTS
- F/u in community as episodes of delirium increase risk of future dementia
What medication should be given for delirium in patients with PD or LB Dementia?
0.5-1mg PO Lorazepam (max 2mg/24h)
What medication should be given for patients with delirium due to acute alcohol withdrawal?
Chlordiazepoxide (benzodiazepine)
What are 4 features of hyperactive delirium?
- Restless
- Agitated
- Heightened arousal
- Aggressive