Delirium

Question 1

What’s worst? Low dose, high dose, or no opioids

Answer 1

Low dose opioids do worse

Question 2

What are the six strongest RF for delirium in the elderly?

Answer 2

Preexisting cog impairment***
Sleep deprivation
Hearing
Visual
Dehydration
Immobility- use of restraints RR 4.4
3 new meds in past 24 hours
IDC insertion 
severe illness
psychoactive drug use

Quadruple risk with restraint use and malnutrition

Question 3

What drug do you pick in delirium with psychotic features?

Answer 3

Haloperidol 0.25-0.5 mg and titrate

no data for risperidone or olanzapine

Question 4

key DSM 5 feature of delirium

Answer 4

Disturbance in attention and awareness (not consciousness)

Question 5

Hypoactive delirium- how is the prognosis different?

Answer 5

Less likely to recover fully

poorer prognosis

Question 6

5 year mortality for delirium

Answer 6

50%

risk greatest where delirium NOT associated with dementia