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.

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.