Delirium as a marker of vulnerability in the elderly

Abstract

Delirium is the clinical expression of an acute cerebral dysfunction caused by various noxious insults. Its prevalence is very high in the elderly, especially in the hospital setting, and in geriatric patients it can be the clinical manifestation of almost every acute disease. Delirium is associated to a number of adverse clinical and functional outcomes, to a higher risk of cognitive decline, institutionalization, and short-and long-term mortality. It is thus necessary to increase the attention on this issue: in fact, it is clearly demonstrated that delirium can be prevented in a large proportion of cases.Delirium is not only a marker of patient vulnerability and clinical instability, but also an index of the quality of care and the efficiency of its organization. By systematically assessing the presence of delirium during the whole length of hospital stay, physicians may closely monitor the patient's clinical status. The aims of this review are to review the current clinical practice in delirium, focusing particularly on elderly individuals. The topics covered include epidemiology and outcomes, causes, clinical features and diagnosis, prevention and treatment. Finally, implications for clinical practice are discussed.

COVID-19 and Frailty

“…However, it can sometimes occur due to the awareness of illness in the initial stages. In the frail elderly, it is more complex to distinguish the onset of this condition since it occurs more frequently with non-specific symptoms such as asthenia, insomnia, and hypochondria [ 69 ]. The best outcomes are obtained in the initial stages when the patient is aware of their symptoms and their condition; while, in the terminal stages, instead, there is no rationale in treating the disorders in the absence of a patient’s real awareness of their condition [ 69 ].…”

“…In the frail elderly, it is more complex to distinguish the onset of this condition since it occurs more frequently with non-specific symptoms such as asthenia, insomnia, and hypochondria [ 69 ]. The best outcomes are obtained in the initial stages when the patient is aware of their symptoms and their condition; while, in the terminal stages, instead, there is no rationale in treating the disorders in the absence of a patient’s real awareness of their condition [ 69 ]. Behavior disorders such as irritability, aggression, motor activity purposelessness, delusions, and hallucinations are frequent in the moderate-severe stage of dementia, and their occurrence in elderly patients is a sign of increased frailty; therefore, a specific drug treatment may be appropriate for use from symptom onset to the terminal stages of life.…”

Vulnerabilidade E Envelhecimento Humano, Conceitos E Contextos: Uma Revisão.

“…Os resultados do estudo evidenciaram cinco publicações (BELLELLI; MAZZOLA; MORANDI, 2015;MANTOVANI;VIEBIG;MORIMOTO, 2018;SALMAZO-SILVA et al, 2009;SALMAZO-SILVA;LIMA;GALHARDI , 2010;WALSTON, 2016), cuja temática aborda a associação da vulnerabilidade com condições clínicas do indivíduo, além de discutirem a relação da presença de vulnerabilidade e seus contextos.…”

“…Delirium é uma expressão utilizada para indicar a presença de disfunções cerebrais causadas por uma série de agentes nocivos, bastante prevalente em ambiente hospitalar, principalmente em pacientes geriátricos, como manifestações clínicas de muitas doenças. Está associado à vulnerabilidade, pois pode se relacionar a vários desfechos clínicos e funcionais adversos, com maior risco de declínio cognitivo, institucionalização e mortalidade a curto e a longo prazo (BELLELLI; MAZZOLA; MORANDI, 2015).…”

“Nabucco” by Giuseppe Verdi: A Case of <b><i>Delirium</i></b> in an Italian Romantic Opera

“…In its hypoactive form, it manifests as an equally sudden withdrawal from interaction with the outside world. Although these 2 forms are distinctive clinically, patients can wax and wane between them during the course of a day or the course of the disorder (mixed type) [8] . Interestingly, delirium may be a harbinger of future negative outcomes including death and cognitive impairment [9,10] .…”