Delirium in Older Adults

Delirium in Older People

• Delirium is a common cause of acute end-organ dysfunction in hospital settings and is associated with significant mortality.
• Delirium is not a disease, but rather a changed mental state characterized by disturbed consciousness, cognitive function, or perception.
• Delirium is often the first presentation of cognitive decline and can be thought of as “acute brain failure,” a multifactorial syndrome analogous to acute heart failure.

Risk Factors for Delirium

• Dementia is the most significant non-modifiable risk factor for delirium in older people, accounting for up to two-thirds of all occurrences.
• Other risk factors include:
  • Advancing age (> 65 years)
  • History of delirium
  • Stroke
  • Neurological disease
  • Falls or gait disorder
  • Hip fracture
  • Multiple comorbidities
  • Chronic renal or hepatic disease

Consequences of Delirium

• Patients need to stay longer in hospital or in critical care—with associated costs.
• The incidence of dementia increases.
• Patients acquire more hospital-acquired complications such as falls and pressure sores.
• Patients are more likely to need to be admitted to long-term care if they are in hospital.
• The rate of functional recovery is poor.
• The rate of mortality increases by 25% in patients with delirium.

Causes of Delirium

• Pre-existing cognitive impairment, such as dementia
• Older age
• Medical illness
• Visual and hearing impairment
• Functional impairment
• Depression
• History of alcohol abuse
• ICU stay
• Infections
• Pain
• Constipation
• Change in environment
• Physical restraints
• Lack of sleep
• Poor nutrition
• Medications
• Dehydration
• Electrolyte abnormalities
• Major surgery
• General anesthesia
• Anticholinergics, opiates, benzodiazepines, corticosteroids
• Alcohol withdrawal
• Sedative-hypnotic drug withdrawal
• Any newly prescribed medication
• Over-the-counter (OTC) remedies, especially those with anticholinergic effects

Delirium Assessment and Diagnosis

• Delirium has an acute onset and typically lasts several days, but can last for weeks to months in some cases.
• Delirium is often missed, even in hospitals, due to a lack of training and understanding that delirium is a medical emergency.
• Education programs are needed to train staff in delirium assessment, including the use of screening tools such as DSM-5, SQiD, CAM, 4AT, and UB-2.

Delirium vs. Dementia

• Delirium and dementia are both disorders where there is broad or widespread cognitive impairment.
• Delirium has a rapid onset and can fluctuate over hours and days.
• Dementia has a slow onset.
• Delirium is a medical emergency and requires rapid treatment, whereas dementia is a chronic condition that requires ongoing management.

Brain Health

• Brain health is the state of brain functioning across cognitive, sensory, social-emotional, behavioral, and motor domains that allows a person to realize their full potential over the life course, irrespective of the presence or absence of disorders.
• Conditions affecting the brain and nervous system emerge throughout the life course and are characterized by disruptions in brain growth, damage to brain structure, and/or impaired brain functioning.
• Timely diagnosis is crucial to ensure optimal disease management.