Group items tagged

People who already have dementia or are particularly frail are at higher risk of acquiring the condition.

Once in hospital, delirium can be caused by a combination of numerous factors, including surgery, infection, isolation, dehydration, poor nutrition and medications such as painkillers, sedatives and sleeping pills.

The primary symptoms are shifting attention, poor orientation, incoherence and poor cognition. Most patients who acquire it must subsequently spend extended periods of time in expensive acute care settings. Some who suffer from the condition experience hallucinations and become aggressive and belligerent. Others, however, become sleepy and lethargic, their silence making the delirium more difficult to detect.

Treating delirium involves providing good basic care, such as ensuring patients are getting enough fluids and nutrients. It also includes reorienting them to their surroundings. Family members should ensure elderly patients have their hearing aids, dentures, glasses or whatever else they need to engage their senses. Other things that can help include daily exercise, removing medications if possible and surrounding patients with familiar objects.

delirium can cause permanent damage to cognitive ability and is associated with an increase in long-term care admissions

Alagiakrishnan is the lead author of a study that concluded health care professionals are not doing enough to identify the predisposing and precipitating factors that lead to delirium, a sentiment echoed by many in the field of geriatric medicine (Can Fam Physician 2009;55:e41-6). The study assessed 132 patients ages 65 and older who were admitted to medical teaching units at the University of Alberta Hospital over a seven-month period and found that 20 of those patients, or 15.2%, developed hospital-acquired delirium.

In Vancouver, British Columbia and Edmonton, Alberta, for example, hospitals have created “acute care for the elderly” units based on a model of elderly care which features multidisciplinary teams of specialists; elderly-friendly surroundings, including comfortable chairs and furnishings such as clocks with large faces and numbers; and policies designed to promote independence and cognitive stimulation, such as requirements that patients use bathrooms rather than bedpans and that they have their meals at central locations rather than in bed. In an effort to be elderly-friendly, other hospitals have introduced such measures as emergency room teams dedicated to detecting delirium or hired staff such as geriatric emergency nurses.

“In pockets, this is happening, but we need a more concerted movement,” says Wong.

It also leads to complications, such as pneumonia or blood clots

“We need to change how we are caring for patients in hospitals and get back to focusing on basic health care needs,” says Dr. Jayna Holroyd-Leduc, an associate professor of geriatrics at the University of Calgary in Alberta.

In a recent paper, Holroyd-Leduc and colleagues found that most interventions for hospital-induced delirium involve strategies to optimize sensory input, improve orientation, provide familiar objects and encourage family visits (www.cmaj.ca/lookup/doi/10.1503/cmaj.080519).