Elderly confusion Flashcards
Confusion and potential reasons
vague, non-medical term
deafness, complex task, cultural differences, brain problem
Confusion or cognition?
cognition
List some components of cognition
memory
language
executive function
perceptual-motor function
Why is assessing cognition important?
relevant to current medical problem
capacity?
increase risk of death, LOS, discharge to care
improve it
alter communication/information/involve family
appropriateness of investigations, tests, treatments
History
onset - rapid? when it started
course - fluctuating, progressive decline
associated features - illness, functional loss
remember collateral history!
2 common causes of cognitive impairment
delirium and dementia
Key features of delirium (3)
disturbed consciousness - hypoactive/hyperactive/mixed
Change in cognition - memory/perceptual/illusions
acute onset and fluctuant
Other features of delirium
disturbed sleep-wake cycle, psychomotor (falls) and emotional
Who gets delirium?
extremes of age
“frail” brain
cognitive frailty eg MND, MS etc
What causes delirium?
no one really knows
maladaptive pro-inflammatory response
What precipitates delirium - loads of examples
infection - UTI drugs - ACEI,NSAIDS brain injury eg stroke environmental changes urinary retention and constipation biochemical disturbance dehydration hypoxia pain sleep disturbance alcohol or drug withdrawl
Why is delirium important?
20-30% of all inpatients
up to 50% post op
up to 85% in last few weeks of life
massive morbidity and mortality
Morbidity and mortality associated with delirium
risk of death, LOS, institutionalisation and persistent functional decline
How to diagnose delirium?
4AT
What to do when we find delirium?
TIME bundle full history and exam explain diagnosis pharmacological measures non-pharm methods
