Elder Care In Hospital

Delirium is a change in mental state, which comes on suddenly, fluctuates over 24 hours, alters consciousness, disturbs thinking and attention, and results in changed behaviour.

According to Canadian Coalition for Seniors' Mental Health, delirium: 

• is a sudden and severe disturbance in thinking.
• can cause changes in a person’s ability to stay alert, remember, be oriented to time or place, speak or reason clearly.
• is a common and serious condition often experienced by older people.
• can be caused by many things including having an infection, recent surgery, various medical conditions, untreated pain, starting, increasing or stopping some medicines, or not eating or sleeping well.
• is sometimes not recognized or is misdiagnosed as another condition such as dementia or depression.
• can often be prevented.

Canadian Coalition for Seniors' Mental Health. (2017). Delirium. https://ccsmh.ca/projects/delirium/

Some predisposing risk factors for the development of delirium postoperatively include:

• Increased age
• Drug or ETOH use
• Multiple co-morbidities
• Severity of illness
• Frailty
• Disability
• Previous delirium
• COPD
• Hypertension
• Ischemic heart disease
• Malnutrition
• Cognitive impairment

Some precipitating factors for older adults developing delirium postoperatively include:

• Surgical complexity and approach
• Hypertension
• Poor glycemic control
• Depth of sedation
• Medications such as scopolamine, benzodiazepines, diphenhydramine, morphine