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Delirium

What is Delirium?

Delirium is a sudden and usually reversible change in mental state that develops over hours to days, marked by fluctuating levels of consciousness, confusion, disturbed thinking, poor attention, and altered behavior. Delirium is a medical emergency.

From Dynamic Health,  Delirium in the Older Person (Bater, 2006; Ignatavicious, 1999; Island Health, 2006). Accessed August 20, 2015 from Island Health: Delirium Resources.

Risk Factors

  • Severe Medical Illness
  • Surgical procedures this admission
  • History of Depression
  • History of Alcoholism
  • Polypharmacy: more than 5 medications
  • Age 65 or older
  • Vision/Hearing Impairment
  • History of cognitive impairment/dementia
  • Previous episode of delirium
  • Electrolyte imbalances
  • Drug or ETOH use
  • Multiple co-morbidities
  • Frailty

  This is not my mom! Delirium Awareness PSA

Geriatric Medicine Research Unit, 2012

Assessment Tools

Select the tabs for more Assessment Tools

About

  • Validated
  • Used internationally - most recommended assessment for delirium
  • Simple and can be used across multiple clinical settings

When to Use

  • All patients can be evaluated, even those with severe drowsiness and agitation

Important Considerations

  • Does not require any physical response
  • Provides the possibility to screen for other forms of cognitive impairment as brief cognitive tests are included

Select the tabs for more Assessment Tools

About

  • Validated
  • Used internationally
  • Adaptation of the Confusion Assessment Method, the most widely used tool for diagnosing delirium by internists and non-psychiatric clinicians.

When to Use

  • All adults admitted to the ICU in order to quickly identify delirium and prevent negative outcome

Important Considerations

  • Rapid (<1 minute), easy to administer
  • ICU patients should be monitored every shift for delirium onset and/or resolution of these symptoms

Select the tabs for more Assessment Tools 

About

  • Ask: Do you feel that [patient's name] has been more confused lately?
  • Good sensitivity regarding validity, does not diagnose. Positive response prompts further assessment.
  • Quick and easy - especially in complex settings

When to Use

  • Busy clinical settings
  • As part of taking a routine medical history

Important Considerations

  • Through regular assessment with SQiD, staff can monitor potential changes in condition

Care Planning for Delirium

Goal: Prompt identification and safe management of delirium Know patient’s baseline so you can recognize a change in patient’s level of confusion/alertness quickly Remember, there is no single treatment for delirium Start with non-pharmacological interventions Think of risk factors, why might this be happening? Pharmacological Interventions are primarily used to manage symptoms of agitation and psychosis. Potential benefits should be balanced against potential for adverse side effects The use of psychotropic medications to treat the symptoms of delirium should be reserved: For patients in significant distress due to agitation or psychotic symptoms In order to carry out essential investigations or treatment To prevent imminent, significant harm to the themselves or others.

Delirium and Dementia

  Barbara, the whole story

Guy's and St Thomas' NHS Foundation Trust, 2014

More Helpful Resources

  This is not my mom! Delirium Awareness PSA

Geriatric Medicine Research Unit, 2012

  Barbara, the whole story

Guy's and St Thomas' NHS Foundation Trust, 2014