Delirium

Question 1

What is delirium?

Answer 1

Acute change in mental state in response to stressors

Question 2

What are the key features of delirium?

Answer 2

Inattention, disturbed consciousness, change in cognition and onset over hours/ days and often fluctuant
Disturbance of sleep wake cycle and psychomotor behaviour

Question 3

What precipitates delirium?

Answer 3

Infection, dehydration, biochemical disturbance, pain, drugs, constipation, hypoxia, alcohol, sleep disturbance, brain injury and changes in environment

Question 4

How common is delirium?

Answer 4

Commonest complication of hospitalisation
20-30% of all medical patients
Up to 50% post-surgery
Up to 80% at end of life

Question 5

Why is delirium important?

Answer 5

Increased rates of hospital acquired harm
Increased risk of death
Longer length of hospital stay

Question 6

How is delirium diagnosed?

Answer 6

4AT
Alertness, AMT4, attention and acute change or fluctuating course
4 or above is possible delirium

Question 7

What do you do when you find delirium?

Answer 7

Treat the cause
TIME bundle
Full history and exam
Explain diagnosis
Pharmacological measures
Non-pharmacological measures

Question 8

What is the non-pharmacological treatment options for delirium?

Answer 8

Re-orientate and reassure
Encourage early mobility and self-care
Correction of sensory impairment
Normalise sleep-wake cycle
Ensure continuity of care
Avoid catheterisation

Question 9

What is the pharmacological management for delirium?

Answer 9

Stop bad drugs
Drug treatment is usually not necessary
If needed start low and slow - 12.5mg quetiapine orally

Question 10

How can delirium be prevented?

Answer 10

Orientation and ensuring patients have their glasses and hearing aids
Promote sleep hygiene
Early mobilisation
Pain control
Identify and treat post-op complications
Maintain hydration
Regulate bladder and bowel function

Question 11

What is important about capacity and delirium?

Answer 11

Does the person have capacity to make decisions
Do they have a legally appointed proxy decision maker - welfare POA or guardian

Question 12

What is the association between delirium and falls?

Answer 12

4.5x more likely to fall if have delirium
Delirium prevention reduces falls also

Question 13

What should not be done for UTIs in older people?

Answer 13

Do not use a dipstick test for the diagnosis of UTI in older people