Elderly - Delirium Flashcards
What are key features of delirium?
Disturbed consciousness Change in cognition Acute onset Disturbance of sleep wake cycle Disturbed psychomotor behaviour Emotional disturbance
What changes in cognition can happen as a result of delirium?
Memory Perception Language Illusions Hallucinations
What precipitated delirium?
Infection - UTI or other Dehydration Biochemical disturbance Pain Drugs Constipation/urinary retention Hypoxia Alcohol/drug withdrawal Sleep disturbance Brain injury Change in environment Emotional distress
How is delirium diagnosed?
4AT test
What do we do when we find delirium?
Treat the cause
Explain diagnosis
Pharmacological/non-pharmacological measures
What is non-pharmacological treatment for delirium?
Re-orientate and reassure agitated patients - use family/carers Encourage early mobility and self care Correction of sensory impairment Normalise sleep-wake cycle Ensure continuity of care Avoid urinary catheterisation Discharge ASAP
What is pharmacological management for delirium?
Stop bad drugs
Only give drugs if danger to themselves or others
How can delirium be prevented?
Orientation and ensuring patients have glasses and hearing aids Promoting sleep hygiene Early mobilisation Pain control Prevention, early identification, and treatment of post-op complications Maintaining hydration and nutrition Regulation of bladder and bowel function Oxygen if appropriate Medication review
Whats important to consider about capacity?
If the person is capable of making decisions about their care
If they have a legally appointed proxy decision maker such as welfare power of attorney
What is the relative risk of falls in someone with delirium?
4.5x more likely
Why shouldn’t dipstick tests be used for diagnosis of UTI in older people?
Many older people have asymptomatic UTI
