Delirium among Home-Dwelling Elderly after a Recent Hospitalization: An Urgent Need for Effective Nursing Interventions

Abstract

Due to the pressure applied on the health care system, the majority of hospitalized el-derly people are quickly discharged home and the care needed is provided by home care ser-vices [1] . An acute confusional state (delirium), which is linked to high percentages of mor-bidity and mortality, is likely to develop amongst this fragile population [2]. T his syndrome, at the crossroads of numerous pathologies, is almost exclusively studied in the hospital en-vironment, which is extremely conducive to the triggering of a delirium episode [3] . The prevalence of delirium among hospitalized elderly people can be as high as 60%. Also, in ap-proximately half of the elderly patients leaving hospital, an episode of delirium (often rather silent) is not detected. By giving careful consideration to the high prevalence of post-hospi-talization confusion, the non-detection and the undertreatment of silent delirium episodes, the negative impact of delirium on the elderly person, his/her loved ones as well as on the home care nurses is expected to be reduced [3]. For the elderly person, the consequences of delirium are numerous. At the biological level, delirium increases the risk of early death. After an episode, the elderly individual often has to accept help with activities of daily living due to the physical and cognitive decline, but sometimes with great difficulty. This decline entails, in the longer term, a risk of institution-alization within the year following the delirium episode [4] . Other discomforts and health problems such as falls, dehydration and malnutrition are also associated with an episode of delirium [5] . Delirium is often related to increased fragility, even in healthy elderly people. For those who are already vulnerable or fragile, delirium may be the trigger for a significant physiological decline causing a decrease in quality of life – sometimes up to the point of