Improving delirium care through early intervention: from bench to bedside to boardroom

Abstract

Delirium is a complex neuropsychiatric syndrome that impacts adversely upon patient outcomes and healthcare outcomes. Delirium occurs in approximately one in five hospitalised patients and is especially common in the elderly and patients who are highly morbid and/or have pre-existing cognitive impairment. However, efforts to improve management of delirium are hindered by gaps in our knowledge and issues that reflect a disparity between existing knowledge and real-world practice. This review focuses on evidence that can assist in prevention, earlier detection and more timely and effective pharmacological and non-pharmacological management of emergent cases and their aftermath. It points towards a new approach to delirium care, encompassing laboratory and clinical aspects and health services realignment supported by health managers prioritising delirium on the healthcare change agenda. Key areas for future research and service organisation are outlined in a plan for improved delirium care across the range of healthcare settings and patient populations in which it occurs.

The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS)

“…Delirium arises as a consequence of a neurological or systemic illness, medications and psychological stress. It is well-recognized that there is a relationship between predisposing (ageing, cognitive impairment) and precipitating (illness severity) factors such that in the setting of multiple (or severe) predisposing factors, fewer (or less severe) precipitating factors are required [4]. Delirium is therefore a sensitive marker of acute illness in vulnerable older people.…”

Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

“…Cluster randomized trials might be appropriate to address real-world barriers to implementation of a standardized approach to screening, prevention, and treatment of delirium. 144 Although not exhaustive, Tables 3 and 4 suggest major themes for future research that would address critically important clinical questions that would further guide the management of delirium and inform clinical practice in palliative care.…”

The utility of the clock drawing test in detection of delirium in elderly hospitalised patients

“…It is common in hospitalised elderly patients and associated with a range of poor outcomes (MacLullich, Beaglehole, Hall, & Meagher, 2009). However, it is often missed in everyday practice due to inadequate screening and problems with misdiagnosis (O'Hanlon et al, 2014) because it is difficult to distinguish from other causes of cognitive impairment by cognitive testing alone (Smith, Breitbart, & Platt, 1995). Thus, a number of scales have been developed which are based on wider diagnostic criteria, to facilitate the detection and to rate the severity of delirium; however, most of these require expert mental-state examination and experienced raters (Adamis, Sharma, Whelan, & Macdonald, 2010).…”