Geriatrics

Question 1

What are the predisposing factors to delirium?

Answer 1

age > 65 years
background of dementia
significant injury e.g. hip fracture
frailty or multimorbidity
polypharmacy

Question 2

What are the predisposing factors of delirium?

Answer 2

Infection particularly UTI
Metabolic- hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
Changes of environment
Cardio, resp, neurological, endocrine condition
Severe pain
Alcohol withdrawal
Constipation

Question 3

What are the features of delirium/ acute confusional state?

Answer 3

Memory disturbance (short term more than long term) 
Agitated or withdrawn 
Disorientation 
Mood changes
Visual hallucinations 
Disturbed sleep cycle 
Poor attention

Question 4

What are the management options for delirium?

Answer 4

treatment of the underlying cause
modification of the environment
the 2006 Royal College of Physicians publication ‘The prevention, diagnosis and management of delirium in older people: concise guidelines’ recommended haloperidol 0.5 mg as the first-line sedative
the 2010 NICE delirium guidelines advocate the use of haloperidol or olanzapine
management can be challenging in patients with Parkinson’s disease, as antipsychotics can often worsen Parkinsonian symptoms
careful reduction of the Parkinson medication may be helpful
if symptoms require urgent treatment then the atypical antipsychotics quetiapine and clozapine are preferred