Geriatrics - Delirium Flashcards
How many elderly patients are affected by delirium?
30% of elderly patients admitted to hospital
What are the risk factors of delirium?
- Over 65
- Background of dementia
- Significant injury e.g. hip fracture
- Frailty
- Polypharmacy
What can cause delirium?
DELIRIUM
Dehydration
Ethanol withdrawal
Long period of constipation
Infection
Raised calcium
Intense pain
Unfamiliar environment
Metabolic- Hyper/hypoglycaemia
How does delirium present?
MAD HATS
Memory
Agitation
Disorientation
Hallucinations
Attention
Temper (mood changes)
Sleep cycle disruption
How is delirium managed?
Treat underlying cause
What medications can be given for delirium?
Haloperidol 0.5mg
Olanzapine
Both sedatives
When is management of delirium challenging?
Parkinson’s patients
Antipsychotics often worsen parkinsonianism
- Careful reduction of Parkinson’s medication can be helpful
- If symptoms require urgent treatment use atypical antipsychotics e.g. Quetiapine and Clozapine
What antipsychotics can be given to patients with Parkinson’s disease?
Clozapine
Quetiapine
What factors of presentation favour delirium over dementia?
- Acute onset
- Impairment of consciousness
- Worse at night, periods of normality
- Hallucinations
- Agitation
- Fear
- Delusions
What scoring tool is used to assess if a patient is experiencing delirium?
4AT
Score of 4 or more suggests delirium or cognitive impairment
What is delirium and dementia?
Delirium
Acute confusional state, with a sudden onset and fluctuating course. Develops over 1-2 days and has a change in consciousness, either hyper or hypoalert
Dementia
Progressive decline in cognitive functioning, occurs over several months. Affects many areas of function
