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Delirium in Elderly Patients:How You Can Help

Delirium in Elderly Patients:How You Can Help

Delirium in older adults needs to be
recognized early and managed as a
medical emergency. Prompt detection
and treatment improve both shortand
long-term outcomes.1,2 Because
delirium represents one of the nonspecific
presentations of illness in elderly
patients, the disorder can be easily
overlooked or misdiagnosed. Misdiagnosis
may occur in up to 80% of cases,
but it is less likely with an interdisciplinary
approach that includes input
from physicians, nurses, and family
members.3

Successful prevention of delirium
requires systematic evaluation of hospitalized
elderly patients. In this article,
I identify key risk factors to be alert for
in the evaluation. I also outline a multidisciplinary
approach to diagnosis
and management.

OVERVIEW

Delirium is characterized by a
global disorder of attention and cognition.
It is present in 10% to 40% of elderly
persons at the time of hospital
admission; the incidence rises to 25%
to 60% during the stay.4 Delirium goes
unrecognized in 32% to 66% of this population.
4 It affects 2.2 million hospitalized
elderly persons at an estimated
cost to Medicare of over $4 billion
(1994 dollars) per year.5

The prevalence of delirium in elderly
patients differs according to the
type of hospital admission; it varies
from 10% to 15% on general medical
and surgical wards to more than 50%
in persons with hip fractures. The risk
of delirium is related to the underlying
health of the patient and the magnitude
and impact of the medical or surgical
intervention. The risk increases
with prolonged length of hospital stay.

Patients may present with the hyperactive,
hypoactive, or mixed form of
delirium.

  • The hyperactive state is often recognized,
    but a misdiagnosis of dementia
    or the administration of antipsychotic
    or sedative drugs alone will
    delay the proper diagnosis and increase
    the complications of delirium.
  • The hypoactive form of delirium
    often goes unrecognized, which results
    in similar delays and complications.
    It is no surprise, therefore, that
    delirium has been associated with
    hospital mortality rates of 10% to 65%
    in addition to an increased risk of
    institutionalization.5-7
  • The mixed form includes the hyperactive
    and hypoactive states. The
    patient may cycle from one to another
    over a period of hours.

Delirium is a predictor of longterm
functional decline and permanent
loss of functional independence.6-8 One
study showed loss of function in an average
of 1 activity of daily living during
hospitalization; delirium was the sole
predictor of this loss of independence.9

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