Understanding Delirium in Older Adults: Causes, Assessment, and Comprehensive Care-View Presentation Slides

View Presentation Slides

Pdf Summary

The document provides a comprehensive outline on delirium in older adults, presented by Kirsten M. Wilkins, MD, of Yale School of Medicine. It focuses on defining delirium, its significance, diagnosis, management, and associated outcomes. Delirium is characterized by a disturbance in attention and awareness, rapid onset, fluctuating course, cognitive impairment, and is a physiological response to a medical condition.<br /><br />Delirium is prevalently recognized in various healthcare settings, especially among hospitalized, post-operative, ICU, and nursing home patients, with higher rates in older adults. Delirium is crucial due to its association with poor recovery, increased morbidity, healthcare costs, dementia, and caregiver burden.<br /><br />Predisposing factors include age, dementia, sensory impairments, and substance use disorders, while precipitating factors comprise medications, surgeries, infections, and metabolic imbalances. Delirium presentations vary from hyperactive, hypoactive, to mixed, affecting cognitive, behavioral, and psychiatric domains, often unnoticed.<br /><br />The diagnostic process involves history-taking, mental status exams, and using tools like the Confusion Assessment Method (CAM) and cognitive tests. Prevention strategies emphasize reducing risk factors like polypharmacy, optimizing elderly care, and utilizing programs like the Hospital Elder Life Program (HELP).<br /><br />Management focuses on identifying and reversing causes, emphasizing non-pharmacological interventions, and cautiously using medications. Antipsychotics are generally reserved for severe agitation but have limited support for routine use in delirium treatment. Benzodiazepines are used for specific withdrawal syndromes. Melatonin shows potential benefits for sleep-related issues, although its role in delirium prevention remains uncertain.<br /><br />Ultimately, delirium is prevalent and significant, requiring attentive recognition, comprehensive evaluation, and strategic management to improve patient outcomes and prevent long-term impacts.

Keywords

delirium

older adults

diagnosis

management

predisposing factors

precipitating factors

Confusion Assessment Method

non-pharmacological interventions

Hospital Elder Life Program

cognitive impairment