Elderly delirium

Question 1

What are the types of delirium?

Answer 1

Hypoactive - Lethargic, stupor
Hyperactive - Combative, agitated &restless

Mixed

Question 2

How does delirium typically present?

Answer 2

with changes in cognition e.g. memory. perception, language & hallucinations

It has an acute onset and fluctuates, typically being worse at night

Can also affect sleep cycle & emotions

Question 3

What causes delirium?

Answer 3

It’s generally triggered by multiple factors such as:

• Infection
• Dehydration or biochemical imbalance
• Pain
• Sleep disturbance
• Drugs (or drug withdrawel)
• Hypoxia
• Brain injury
• Environment or social changes
• constipation/urinary retention

Question 4

How do we diagnose Delirium?

Answer 4

It’s a clinical diagnosis and we can use the 4AT score to help us. 4 or more points = possible delirium +/- cognitive impairment

Question 5

What’s included in a 4AT score?

Answer 5

Alertness
AMT4 (Age, DOB, location & yr)
Attention (tell me months of year backwards starting at december)
Acute change or fluctuation

Question 6

How do we assess a patient with delirium?

Answer 6

Full H & E including neuro

Time bundle - A systematic way of identifying triggers and initiating treatment

Question 7

What non-pharmacological ways can we treat delirium?

Answer 7

First make sure you explain delirium to the patient and carer.

• Reassurance
• Encourage early mobility
• Correct any sensory impairment
• Normalise sleep-wake cycle
• Ensure continuity of environment & carers
• Avoid catheters and venflons

Question 8

When would you use drugs in delirium?

Answer 8

Only if distress can’t be resolved otherwise.
Or if a danger to themselves or others

DONT JUST SEDATE THE POOR FUCKERS

Question 9

What drugs can you use for delirium?

Answer 9

Firstly stop potentially precipitating drugs, mostly anti-cholinergics and sedatives

Start with low dose of 12.5mg quetiapine orally

Question 10

why is it so important to recognise delirium?

Answer 10

• Commonest complication in hospitilisation
• 20-30% of all in patients
• Up to 50% of people post-surgery
• Up to 85% of people at the end of their life

Question 11

How to prevent delirium?

Answer 11

• Orientation
• Promoting sleep hygiene
• Early mobilisation
• Pain control
• Prevention, early identification, treatment
• Regulation of bladder and bowel function

Question 12

Things to remember to relation in relation to delirium

Answer 12

• capacity/content

- Fall 4.5 more likely