Managing delirium in older people

Abstract

Learning objectives After reading this article it is anticipated the reader will be able to: 1.identify drugs that may contribute to a delirium 2.recognise different ways in which delirium can present 3.describe the main objectives of management 4.describe the main interventions to manage delirium 5.outline some of the interpersonal issues in managing delirium Delirium—also known as Acute Confusional State—is a common health problem in elderly people, with those in care settings at particular risk. is an acute, largely reversible, disorder of cognition marked by impaired attention, fluctuations in the presentation, and frequently disturbances of, perception. A clinical syndrome rather than a discrete disorder, it is not dementia. Often misidentified, with delirium are frequently mis-treated, even when symptoms are recognised. The cause of much distress and disability, it impairs cognitive and physical function and can lead to death. Although it will be briefly addressed here, the recognition of delirium is dealt with more completely in Delirium in older people (Harding 2004) and elsewhere. can arise with almost any medical condition or treatment and may be the only indicator of the presence of physical disorder. Though it rarely has a single cause, many potential causes or risk factors are readily identified and should be addressed as part of appropriate management. The introduction of routine cognitive screening—with appropriate investigation of sudden changes in cognition and function—would improve the identification of cognitive impairment in general and acute cognitive change in particular. People involved in the treatment and care of older may then consider delirium as a cause for cognitive or functional change before deciding that someone is demented.