geriatrics: delirium Flashcards
what is delirium?
acute change in mental state:
- disturbed consciousness
- change in cognition
what are common features of delirium?
- disturbance of sleep wake cycle
- disturbed psychomotor behaviour (affects physical function)
- emotional disturbance
What is the aetiology of delirium?
- Unknown
describe the epidemiology of delirium (age group. % of all patients)?
more common in older people
20-30% all in patients
What are risk factors for delirium?
frailty
can be precipitated by
- CNS: brain injury, hypoxia, sleep disturbance
- renal: dehydration, biochemical disturbances, urinary retention/constipation
- general: infection, pain, alcohol/drug withdrawal, drugs
how is delirium diagnosed?
4AT form
measures
- alertness
- AMT4
- attention
- acute change or fluctuating course
what investigations should be done for delirium?
- 4AT form
- TIME bundle
- comprehensive geriatric assessment
what is TIME bundle
T: assess and exclude possible triggers
I: investigate and intervene to correct underlying causes
M: management plan
E: engage and explore
describe the management for delirium?
non-pharmacological
- hydration and nutrition
- orientation
- promoting sleep hygiene
- pain control
- early mobilisation
- regulation of bowel and bladder function
pharmacological: no medications are proved to improve delirium
what are possible complications of delirium?
massive morbidity and mortality
- longer length of stay in hospital
- persistent functional decline
- psychological impact
- 4.5x more likely to have a fall
describe the prognosis of delirium?
usually settles quickly with management of underlying cause
more likely to develop dementia & further episodes of delirium
What is the relationship between capacity and delirium?
need to consider is the person capable of making decisions about their care
or
do they need a legally appointed proxy decision maker: welfare POA or guardian
How should UTIs be NOT diagnosed by in the elderly?
UTI is blamed too much for delirium – although it is a possible cause:
- Do not use dipstick tests for diagnosis of UTI in older people
