Delirium in Older Adults
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Questions and Answers

What is the estimated percentage of older people in hospital who are affected by delirium?

  • 14–56% (correct)
  • 10–20%
  • 80–90%
  • 60–70%

    • What is the most significant non-modifiable risk factor for delirium in older people?

  • Stroke or neurological disease
  • History of delirium
  • Advancing age (> 65 years)
  • Dementia (correct)

    • What is the typical duration of delirium?

  • Several months
  • Several days (correct)
  • Several weeks
  • Several hours

    • What is delirium often the first presentation of?

    <p>Cognitive decline</p> Signup and view all the answers

    What is the consequence of delirium that should be assessed as a medical emergency?

    <p>Significant mortality</p> Signup and view all the answers

    What is delirium analogous to?

    <p>Acute heart failure</p> Signup and view all the answers

    What is the increased risk of mortality in hospitalized patients with delirium?

    <p>25%</p> Signup and view all the answers

    What is the most significant risk factor for developing delirium?

    <p>Pre-existing cognitive impairment</p> Signup and view all the answers

    Which of the following medications is a risk factor for delirium?

    <p>Anticholinergics</p> Signup and view all the answers

    What is a common consequence of delirium in patients?

    <p>Increased risk of dementia</p> Signup and view all the answers

    What is a characteristic of delirium in terms of duration?

    <p>It often lasts for a few days</p> Signup and view all the answers

    Which of the following is a behavioral change associated with delirium?

    <p>Restlessness and agitation</p> Signup and view all the answers

    What is a cognitive impairment associated with delirium?

    <p>Difficulty recalling words</p> Signup and view all the answers

    What is a common emotional disturbance associated with delirium?

    <p>Euphoria</p> Signup and view all the answers

    Which of the following is a risk factor for delirium in older adults?

    <p>All of the above</p> Signup and view all the answers

    What is a common consequence of delirium in terms of hospital stay?

    <p>Longer hospital stay</p> Signup and view all the answers

    Which of the following symptoms is suggestive of a demyelinating etiology?

    <p>Waxing and waning course with exacerbations and remissions</p> Signup and view all the answers

    What is the primary purpose of the neurologic history in neurologic assessment?

    <p>To organize the examination by components of the nervous system</p> Signup and view all the answers

    Which type of aphasia is characterized by a slow, halting manner of speech?

    <p>Expressive aphasia</p> Signup and view all the answers

    What is the primary purpose of the Babinski sign in emergency situations?

    <p>To quickly assess for upper motor neuron lesions</p> Signup and view all the answers

    What is the focus of the physical exam in the neurological examination for Parkinson's disease?

    <p>Assessing postural instability</p> Signup and view all the answers

    What is the primary purpose of the falls risk assessment in the neurological examination for multiple sclerosis?

    <p>To determine the patient's risk of falls</p> Signup and view all the answers

    What is the focus of the physical exam in the neurological examination for peripheral neuropathy?

    <p>Assessing muscle strength and reflex loss</p> Signup and view all the answers

    What is the most important part of neurologic assessment?

    <p>Neurologic history</p> Signup and view all the answers

    What is the significance of the Babinski sign in neurology?

    <p>It is one of the most important signs in neurology</p> Signup and view all the answers

    What is brain health defined as?

    <p>The state of brain functioning across cognitive, sensory, social-emotional, behavioral, and motor domains</p> Signup and view all the answers

    What is a person with hyperactive delirium likely to exhibit?

    <p>Restlessness, agitation, and resistance to personal care</p> Signup and view all the answers

    What is the primary difference between delirium and dementia?

    <p>The rate of onset of symptoms</p> Signup and view all the answers

    What is the term for a person experiencing both hyperactive and hypoactive delirium symptoms?

    <p>Mixed delirium</p> Signup and view all the answers

    What is the reason for under-diagnosis of delirium in hospitals?

    <p>All of the above</p> Signup and view all the answers

    What is the goal of delirium prevention strategies?

    <p>Reducing modifiable risk factors for delirium</p> Signup and view all the answers

    What is brain health?

    <p>A state of brain functioning that allows a person to realize their full potential</p> Signup and view all the answers

    What is the most commonly used bedside assessment tool for delirium?

    <p>CAM</p> Signup and view all the answers

    What is the consequence of inadequate delirium prevention and management?

    <p>Increased risk of mortality and disability</p> Signup and view all the answers

    What is the primary reason for the difference in diagnosing delirium and dementia?

    <p>The similarity in symptoms between the two conditions</p> Signup and view all the answers

    What is the term used to describe the occurrence of delirium in a person with dementia?

    <p>Delirium superimposed on dementia</p> Signup and view all the answers

    Study Notes

    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.

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    Description

    Learn about delirium in older adults, its prevalence in hospitals, and its effects on functional decline, independence, and mortality. Understand delirium as a changed mental state rather than a disease.

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