Management of Delirium in Critically Ill Older Adults

Abstract

Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients’ family members.

Early rehabilitation in the intensive care unit: An integrative literature review

“…21 The prevalence of delirium in critically ill patients as been reported as high as 83% in the USA and has been associated with many unfavourable functional outcomes that can reach into the post ICU discharge period. 34 Nurses are in an excellent position to use validated screening tools to screen patients for delirium and to maintain target sedation scores. 35 Respiratory weaning from mechanical ventilation and spontaneous breathing trials was shown as an important component of the rehabilitation process.…”

Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

“…3,5 As in a multitude of other ailments, prevention is the optimal strategy, especially when effective treatment options are unavailable. Haloperidol has been studied for prevention and treatment of ICU delirium, but the results have been inconclusive.…”

Cornell Assessment of Pediatric Delirium

“…Pediatric delirium is associated with increased length of PICU stay (10), posttraumatic symptoms (11), and possible neurocognitive dysfunction in children after discharge (12, 13). A growing body of literature in adult critical care describes delirium as exacerbated by the use of various sedative medications and has identified risk factors that predispose to delirium (5, 14–17). An impediment to the progress of pediatric delirium research has been the absence of an easily administered and widely applicable screening tool.…”