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Delirium is considered a quality indicator in the care of hospitalized older patients. A better understanding of the pathophysiology of delirium and some effective strategies for diagnosis, prevention, and management can help clinicians ensure that patients affected by delirium receive the care they need.
Risk factors and pathophysiology Delirium can arise following one single destabilizing medical event, but more often multiple factors contribute to its initiation and development.
Therapy focuses on treating the triggering cause as well as addressing patient-specific and environmental risk factors that may contribute to the development or worsening of delirium.
Ideally, nonpharmacological strategies should be used to address six risk factors that contribute to delirium: cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration.
It is not uncommon for patients to have both forms at various times during the course of the same illness.
It is particularly easy to miss a patient with hypoactive delirium as they do not call attention to themselves, perhaps explaining why the hypoactive form is associated with a poorer prognosis. The diagnosis of delirium requires a patient interview, a physical examination, cognitive testing, and a review of the medical chart and any collateral information. Delirium and physical restraint in the hospitalized elderly.
Screening tools are an attractive adjunct to clinical assessment, especially if time is limited. O’Mahony R, Murthy L, Akunne A, Young J; Guideline Development Group.