• Primary Care of Telfair

Delirium in Older Adults and How to Avoid this - From the Desk Of Dr Aaliya Amer

The term “Delirium” was first used as a medical term in first century AD to describe mental disorder resulting from high fever and head injury. Delirium is a condition which is related to older age. the features of this disease include acute confusional state, inattention, cognitive dysfunction and cerebral insufficiency. It results in forgetfulness, confusion and less control and coordination among body functions. Delirium has variable presentation in different individuals. Delirium is usually misdiagnosed or under diagnosed due to its variations in different patients. But delirium can be prevented and its symptoms can be managed. The management depends on the symptoms the patient displays.



Delirium In Adults And Who Would It Initiate?

Delirium is usually initiated due to a head trauma or high and prolonged fever in old people. The symptoms of delirium are quick and abrupt. The symptoms usually start to show up with in a few hours to a couple of days.

In medical terms the word delirium is used to describe a set of acute transient, fluctuating and reversible syndrome. Delirium can be short termed or chronic. In short termed delirium the symptoms show for a certain time period. Chronic delirium may result into decreased body functions, loss of independence and ultimately death.


In United States of America, almost 14%-55% of the hospitalized elders are affected with delirium. And almost 20% of 65 year old and more elders are hospitalized due to delirium. More than 70% of hospitalized elderly patients also get affected with delirium.

What Are Some Risks Being Attached With Delirium

· Dementia ( present in more than two- third patients of delirium )

· Lost of vision or sight

· Immobilization

· Surgery

· Pain

· Emotional disturbance

· Environment

· Prolonged sleep deprivation

· Stroke

· Medications

· Meningitis

· Poor nutrition

· Fracture

· Trauma

· Severe illness

· Dehydration

· Infection

· Advancing age

· Multiple comorbidity


What Are Some Ways to Diagnose Delirium


The standard clinical diagnosis of delirium includes clinical history, cognitive and behavioral observations by regularly visiting Geriatric Doctor Near You The history should confirm an acute change in the baseline cognitive functions.

The history should include any changes in the mental health, medications, changes in the environment, alcohol withdrawal and intracellular sickness. Conditions which resemble to delirium should not be included in the history.



Diagnosis Of Delirium In Patients In ICU:

For the patients in ICU some procedures like Intensive Care Delirium Checklist or Confusion Assessment method for ICU are used. These methods are used for the elderly patients who are admitted in the ICU and are unable to speak. In the elderly patients delirium can be the first step of other serious diseases.

The Confusion Assessment Method ( CAM):

The confusion assessment method (CAM) includes the standard tests and diagnostic algorithm for the diagnosis of delirium. The Confusion assessment method relies on the presence of serious onset symptoms and a fluctuating course, inattention, diagnosed thinking and an altered level of consciousness.

This algorithm has an accuracy of 94% - 100% and a specificity of 90% - 95% if used by a trained interviewer. In the recent meta -analysis in 1071 patients the Confusion Assessment method has a sensitivity of 95% and a specificity of 89%.

The results of confusion assessment method might be compromised if it is used by an undertrained interviewer.

Prevention Strategies:

Here is a list of few things which we can do to prevent delirium in elderly individuals.

· Talk to the patient clearly

· Ask short questions

· Ask one question at a time

· Help the patient with visual and hearing aid

· Make sure the hearing and visual aids are in a good condition

· Educate the family members of the patient about delirium

· Educate the caretaker of the patient about delirium

· Use the key words like “ this is me” with the patient


How to Minimize the Patient’s Confusion?

· Here are some tips to reduce the patient’s confusion.

· Use a clock

· Keep the clock near the patient

· Use calendars

· Avoid changing rooms

· Use words signs

· Talk about news

· Talk about their past

· Talk about their surroundings

· Encourage cognitive stimulation

· Encourage small talks

· Light the room for daytime

· Avoid daytime napping

· Encourage nighttime sleep

· Encourage small talks

· Encourage the patient’s family for frequent visits

How to Encourage Mobility and Independence in a Patient of Delirium?

Here are a few strategies to encourage independence and mobility in the patients of delirium.

· Decrease falling risks

· Encourage them to do their daily routine activities

· Encourage them to do a little exercise

· If possible, provide the patient walk aid

· Make sure the walking aid is accessible

· For the patients who are unable to walk – encourage them to do in bed exercises

Other Things Which Might Help in the Prevention of Delirium

· Good nutrition which avoids constipation and dehydration

· Use message and other relaxation techniques

· Avoid permanent catheters

· Avoid using medications without the prescription of a doctor

· Avoid using antipsychotic drugs

· Make sure the patient is in no pain

· Check for pain cues

· Promote a peaceful night time sleeping environment

· Make sure the patient is getting adequate night sleep

· Keep the environment calm and quiet

Treatment strategies which used for the patients of delirium:

The main strategy used in the treatment of delirium is to create an environment which is calm and healing for the brain and the body.

The treatment of delirium includes both supportive and medical care like:

· Use drugs which are needed to reduce the pain which is causing delirium as prescribed by the doctor

· Avoid using drugs which might trigger delirium

· Use medications to calm the patient

· Use medications to reduce the fear and hallucinations in the patient

· Maintain a calm environment

· Encourage the visits of family and friends

· Maintain a good nutrition

· Protect the airways

· Assist in movement

· Provide visual and hearing aid

· Encourage the patient to maintain a social circle

· Avoid infections

· Treat pain

· Promote a night sleep

Conclusion:

Delirium is a common condition among elderly people and it might be very dangerous and even fatal if it is not treated and addressed in proper time and with proper attention.

Delirium can be contained and cured by providing supportive care ,regular and adequate medication. However, it is always recommended to consult a specialist.


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