Delirium in older adults

Abstract

This narrative review provides a broad examination of the most current concepts on the etiopathogenesis, diagnosis, prevention, and treatment of delirium, an acute neuropsychiatric syndrome characterized by fluctuating changes in cognition and consciousness. With the interaction of underlying vulnerability and severity of acute insults, delirium can occur at any age but is particularly frequent in hospitalized older adults. Delirium is also associated with numerous adverse outcomes, including functional impairment, cognitive decline, increased healthcare costs, and death. Its diagnosis is based on clinical and cognitive assessments, preferably following systematized detection instruments, such as the Confusion Assessment Method (CAM). Delirium and its consequences are most effectively fought using multicomponent preventive interventions, like those proposed by the Hospital Elder Life Program (HELP). When prevention fails, delirium management is primarily based on the identification and reversal of precipitating factors and the non-pharmacological control of delirium symptoms. Pharmacological interventions in delirium should be restricted to cases of dangerous agitation or severe psychotic symptoms.

DELIRIUM+ as a mnemonic device to optimize delirium-related teaching and clinical care

“…A incidência de delirium na população citada varia conforme o cenário intra-hospitalar, podendo alcançar 80% dentro de ambientes de cuidado intensivo e em pacientes terminais, por exemplo. 2,3 A ocorrência dessa condição está associada a aumento do risco de mortalidade intra-hospitalar em até 12 meses após a alta, além de maior frequência de institucionalização e de desenvolvimento de quadros demenciais. 4 O delirium desencadeia uma cascata de eventos que pode levar a declínio funcional potencialmente progressivo, aumento do tempo de permanência hospitalar, necessidade de aumento de equipe de cuidado, além do aumento de morbidade e mortalidade, que levam a um significativo aumento dos custos em saúde.…”