Delerium Flashcards
What is delirium?
Delirium = acute change in mental state with the following key features
- Disturbed consciousness (hypoactive/hyperactive/mixed)
- Change in cognition (memory, perceptual, language, illusions, hallucinations)
What are key and common features of delirium?
Delirium = acute change in mental state with the following key features
- Disturbed consciousness (hypoactive/hyperactive/mixed)
- Change in cognition (memory, perceptual, language, illusions, hallucinations)
Other common features:
- Disturbance of sleep wake cycle
- Disturbed psychomotor behaviour (affects physical function)
- Emotional disturbance
What is the aetiology of delirium?
- Unknown
Describe the epidemiology of delrium (age group. % of all patients)?
- More common in older people
- 20-30% all in patients
What are risk factors for delirium?
- Frailty
- Can be precipitated by
- Infection
- Dehydration
- Biochemical disturbances
- Pain
- Drugs
- Urinary retention/constipation
- Hypoxia
- Alcohol/drug withdrawal
- Sleep disturbance
- Brain injury
How is delirium diagnosed?
- 4AT form
- Measures alertness, AMT4, attention, acute change or fluctuating course
What investigations should be done for delirium?
- 4AT form
- Measures alertness, AMT4, attention, acute change or fluctuating course
- TIME bundle
- Assess and exclude possible triggers, investigate and intervene underlying causes, management plan, engage and explore
- Comprehensive geriatric assessment
What is measured in a 4AT form?
- 4AT form
- Measures alertness, AMT4, attention, acute change or fluctuating course
Describe the management for delirium?
- Prevention measures
- Orientation, promoting sleep hygiene, pain control, early mobilisation, hydration and nutrition, regulation of bowel and bladder function
- Non-pharmacological
- Re-orientate and reassure
- Encourage early mobility
- Normalise sleep/wake cycle
- Avoid frequent changes to wards/rooms
- Discharge ASAP
- Pharmacological
- Stop bad drugs if you can
- No medications are proved to improve delirium
- Maybe anti-psychotics if danger to themselves or others but decision by consultant
What are possible complications of delirium?
- Massive morbidity and mortality
- Longer length of stay in hospital
- Increased rates of institutionalisation
- Persistent functional decline
- Psychological impact
- 4.5x more likely to have a fall
Describe the prognosis of delirium?
- Usually settles quickly with management of underlying cause
- More likely to develop dementia
- Risk factor for further episodes of delirium
What is the relationship between capacity and delirium?
In delirium, need to consider is the person capable of making decisions about their care or do they need a legally appointed proxy decision maker:
- Welfare POA or guardian
How should UTIs be NOT diagnosed by in the elderly?
UTI is blamed too much for delirium – although it is a possible cause:
- Do not use dipstick tests for diagnosis of UTI in older people
