Delirium

Question 1

what is delirium?

Answer 1

an acute change in mental state in response to a stressor(s)

Question 2

delirium clinical features

Answer 2

• inattention
• disturbed consciousness e.g. hypoactive, hyperactive, mixed
• change in cognition e.g. memory/perceptual/language/illusions/hallucinations
• onset over hours/days and often fluctuant

other common features:
- disturbance of sleep wake cycle
- disturbed psychomotor behaviour

Question 3

what are some potential causes for delirium?

Answer 3

• infection (but not always a UTI!)
• dehydration
• biochemical disturbance
• pain
• drugs
• constipation/urinary retention
• hypoxia
• alcohol/drug withdrawal
• sleep disturbance
• brain injury e.g. stroke/tumour/bleed etc.
• changes in environment/emotional distress
• sometimes no idea and often multiple triggers!

Question 4

how common is delirium?

Answer 4

• most common coplication of hospitalisation
• 20-30% of all medical in-patients
• up to 50% of people post-surgery
  up to 85% of people at the end of their life

Question 5

what score system is used to diagnose delirium?

Answer 5

4AT

Question 6

delirium management

Answer 6

4AT score

Treat the cause:
- full history and exam (inc. neuro)
- TIME bundle

Explain the diagnosis!

• Pharmacological measures
• non-pharmacological measures

Question 7

delirium non-pharmacological treatment

Answer 7

• re-orientate and reassure > use families/carers
• encourage early mobility and self-care
• correction of sensory impairment
• normalise sleep-wake cycle
• ensure continuity of care: avoid hospitilisation if possible, avoid frequent ward or room transfers.
• avoid urinary catheterisation/venflons
• discharge people (if in hospital) ASAP

Question 8

delirium pharmacological management

Answer 8

• stop bad drugs (if you can)
• drug treatment of delirium usually not necessary
• no evidence it improves outcome
• only if danger to themselves or other which cannot be settled in any other way: start low and go slow, 12.5mg quetiapine orally, this should be a consultant/registrar decision

Question 9

what is the association between delirium and falls?

Answer 9

4.5x more likely to fall if you have delirium
- delerium prevention interventions reduce falls also

Question 10

what do the sign 88 guidelines say about treating bacteriuria in elderly women?

Answer 10

In elderly women (>65yrs), treatment of
asymptomatic bacteriuria does not reduce mortality or symptomatic episodes. Antibiotic treatment
significantly increases the risk of adverse events (NNTH 3).

• do not use dipstick tests for the diagnosis of UTI in older people