Podcast
Questions and Answers
What is the approximate percentage of patients in nursing homes or postacute settings who experience delirium?
What is the approximate percentage of patients in nursing homes or postacute settings who experience delirium?
- 40%
- 60% (correct)
- 50%
- 30%
What is the mortality rate associated with delirium?
What is the mortality rate associated with delirium?
- 22% to 76% (correct)
- 40% to 50%
- 10% to 30%
- 15% to 25%
Which patient demographic is most common to experience delirium during hospitalization?
Which patient demographic is most common to experience delirium during hospitalization?
- Younger adults
- Pediatric patients
- Patients with chronic illnesses
- Older medical patients (correct)
What is NOT a characteristic of delirium?
What is NOT a characteristic of delirium?
What is the range of one-year mortality rate associated with cases of delirium post-hospitalization?
What is the range of one-year mortality rate associated with cases of delirium post-hospitalization?
In what setting is delirium most commonly observed?
In what setting is delirium most commonly observed?
Which of the following is considered a predisposing factor for delirium rather than a precipitating factor?
Which of the following is considered a predisposing factor for delirium rather than a precipitating factor?
Which of the following is a critical aspect of managing delirium?
Which of the following is a critical aspect of managing delirium?
In which setting is delirium most likely to be complicated following major operations in older adults?
In which setting is delirium most likely to be complicated following major operations in older adults?
Which primary feature distinguishes delirium from other conditions?
Which primary feature distinguishes delirium from other conditions?
What is the common postoperative complication for older patients with hip fractures?
What is the common postoperative complication for older patients with hip fractures?
What factor is NOT considered a risk for developing delirium?
What factor is NOT considered a risk for developing delirium?
Which of the following is NOT considered a common risk factor for delirium?
Which of the following is NOT considered a common risk factor for delirium?
Why is early recognition of delirium essential in clinical practice?
Why is early recognition of delirium essential in clinical practice?
Clinicians fail to recognize and address postoperative delirium in what percentage of cases?
Clinicians fail to recognize and address postoperative delirium in what percentage of cases?
What is one potential consequence of untreated delirium?
What is one potential consequence of untreated delirium?
Which mnemonic represents seven potentially fatal etiologies relevant to delirium?
Which mnemonic represents seven potentially fatal etiologies relevant to delirium?
What feature is considered the most consistent symptom of delirium?
What feature is considered the most consistent symptom of delirium?
Which of the following is a hallmark of delirium characterized by sudden changes in mental status?
Which of the following is a hallmark of delirium characterized by sudden changes in mental status?
What is the critical mistake when assessing acute inattention in elderly patients?
What is the critical mistake when assessing acute inattention in elderly patients?
Which risk factor acronym is associated with delirium symptoms?
Which risk factor acronym is associated with delirium symptoms?
What is NOT a characteristic of cognitive symptoms in delirium?
What is NOT a characteristic of cognitive symptoms in delirium?
Which aspect is considered a part of the assessment of a patient's mental status to identify delirium?
Which aspect is considered a part of the assessment of a patient's mental status to identify delirium?
Which disturbance is common in delirium and affects the ability to focus attention?
Which disturbance is common in delirium and affects the ability to focus attention?
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Study Notes
Epidemiology
- Delirium is prevalent in various settings, including ICU (70-80%), nursing homes (up to 60%), emergency departments (40%), and hospitals (30% of older medical patients, 1 in 7 hospitalized patients).
- It also complicates 15-50% of major operations in older adults.
- One-year mortality rate associated with delirium is 35-40% following hospitalization.
- Clinicians often miss or fail to address postoperative delirium, up to 80% of the time.
Delirium is a Life-threatening Neuropsychiatric Emergency
- Characterized by an acute change in attention and awareness, caused by a severe systemic illness.
- Not explained by pre-existing neurocognitive disorders.
- Delirium is fatal (mortality rate 22-76%, with 20% increase in mortality risk per day of delirium).
- Delirium is transient, reversible, preventable, and has poor clinical outcomes if untreated.
Delirium: A Neuropsychiatric Symptom
- Delirium is a secondary symptom arising from systemic disturbances caused by an acute and/or severe systemic illness.
- It is often considered multifactorial.
- It can be found wherever there are sick patients.
- Up to 83% of patients at the end of life experience delirium.
Risk Factors
- Precipitating factors: newly acquired insults or hospital-related factors.
- Predisposing factors: pre-existing vulnerabilities that increase the risk of delirium.
- Common risk factors:
- Advanced age (>65 years)
- Dementia
- Visual and hearing impairments
- Sensory deprivation
- Reduced mobility
- Dehydration
- Poor nutrition
- Polypharmacy
- Multiple comorbidities
Etiopathogenesis
- Delirium often arises from a complex interplay of predisposing and precipitating factors, making it difficult to pinpoint a singular cause.
- In most cases, delirium is the only manifestation of the systemic illness.
I WATCH DEAD
- Infection
- Withdrawal
- Acute metabolic
- Toxic
- Central nervous system (CNS)
- Hypoxia
- Deficiency
- Electrolyte disturbance
- Acute vascular
- Drugs
Clinical Scenario
- Characterized by four distinct features:
- Altered consciousness: sleepiness, hyperactivity, or alternating states
- Cognitive change: inattention
- Acute onset: sudden change in the patient
- Fluctuating course: unpredictable changes in cognition and consciousness.
Cognitive Symptoms: Inattention
- The most consistent feature of delirium.
- Impacts the ability to focus, shift, and sustain attention.
- Memory impairments, both short- and long-term, are common.
- Disorientation to time, place, and person is prevalent.
- Visuo-spatial disturbances and executive dysfunction.
- Acute inattention in the elderly should not be considered a typical or benign aspect of aging.
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