Management of older and senile patients with a high risk of delirium when providing inpatient care. Clinical protocol

Abstract

Delirium is an acute, life-threatening condition manifested by disturbance in consciousness, attention and cognition, which has a multifactorial genesis, severe consequences and commonly seen in older and senile people inpatient. Clinical experience in domestic practice shows that delirium diagnosis in older and senile patients is often missed, and its signs may be considered as manifestations of other diseases, while the state of delirium is often perceived only as an alcohol withdrawal. The article presents a clinical protocol developed and based on the firsthand experience and modern ideas by a multidisciplinary team of the Russian Gerontology Research and Clinical Centre, in which the delirium in older and senile people is considered as a geriatric syndrome. The article shows the latest diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main diagnostic tools are given — Confusion assessment method (CAM), diagnostic and differential diagnostic algorithms; clinical subtypes, management tactics, non-drug and drug approaches to treatment, as well as principles for the prevention of geriatric delirium are described.