Geriatrics- Delirium

Question 1

What is delirium?

Answer 1

Acute change in mental state in response to stressors

Question 2

What are some of the key features of delirium?

Answer 2

Inattention
Disturbed consciousness- hyperactive/hypoactive
Change in cognition

Question 3

What is the onset of delirium?

Answer 3

Acute onset- hours to days

Question 4

What age group can get delirium?

Answer 4

Extremes of age- young and old

Question 5

List some of the things that can drive delirium.

Answer 5

Infection
Dehydration
Biochemical disturbance
Drugs
Constipation/urinary retention
Hypoxia
Alcohol/drug withdrawal

Question 6

Why are anticholinergics bad in older people?

Answer 6

Can cause falls and delirium
Often part of the reason people are moved into care homes

Question 7

What is the screening tool used for delirium?

Answer 7

4AT Score

-> everyone older than 65 should be screened upon acute admission, very important screening tool

Question 8

What does the 4AT score involve?

Answer 8

Alertness
Ability to answer basic questions e.g. age, DOB, location, year
Attention- naming the months backwards from December
Acute changes- asking those close to the patient if any changes have been noticed

Question 10

What are some of the non-pharmacological treatments of delirium?

Answer 10

Re-orientate and reassure, use family/carers to do this too! More comforting from someone they know
Encourage early mobility and self-care
Correction of sensory impairment
Normalise sleep-wake cycle
Ensure continuity of care
Avoid unnecessary medical procedures e.g. catheters

Question 12

Which drugs can cause delirium, or make it worse?

Answer 12

Opiates
Sedative drugs e.g. sleeping tablets
Anti-cholinergic drugs

Question 13

When would you need to give a medical treatment for delirium?

Answer 13

May give anti-psycotic to reduce stress, but only if cannot be settled in any other way

Question 14

What are some of the measures which can help to reduce risks of delirium?

Answer 14

Orientation and ensuring patients have glasses
Promote sleep hygiene
Early mobilisation
Maintaining optimal hydration and nutrition
Regulation of bowel and bladder function

Question 15

Patients with delirium are more likely to develop which condition?

Answer 15

Dementia

Question 16

What is the link between and falls and delirium?

Answer 16

Those with delirium are 4.5x more likely to fall

Question 17

How can we reduce risks of patients with delirium falling?

Answer 17

Early mobilisation- encourage patients to keep moving, don’t tell them to sit down incase they fall!!!

Question 18

Why are urine dips less useful in older people, especially in women?

Answer 18

Will come back positive but does not mean they have a UTI!! A lot just have WBC’s in the bladder

Question 19

When is the only time urine dips are useful in older people?

Answer 19

To assess proteinuria

-not useful in infection.