Delirium Among Elderly PDF

Delirium among elderly 1. Define delirium; 2. Enumerate different characteristics of delirium; 3. Identify possible causes of delirium; 4. Discuss different ways to detect occurrence delirium; 5. Identify ways in evaluating delirium using IN and OUT approach; 6. Explain possible treatmen...

Delirium among elderly 1. Define delirium; 2. Enumerate different characteristics of delirium; 3. Identify possible causes of delirium; 4. Discuss different ways to detect occurrence delirium; 5. Identify ways in evaluating delirium using IN and OUT approach; 6. Explain possible treatment of delirium; and 7. Discuss different interventions in managing delirium. delirium  Also called acute confusion.  Frequently seen in older adults.  A medical/surgical diagnosis with psychiatric manifestations. CHARACTERISTICS OF DELIRIUM IN THE ELDERLY  Abrupt onset  Maybe associated with a change in medications or  Time limited dosing  Often associated with an acute illness such as UTI  Altered level of consciousness  Fluctuates during the day   Disorientation  Short attention span  Disorganized thinking  Impaired memory  A decreased Mini Mental State Examination (MMSE) DELIRIUM but we must remember that:  A score of 23 out of 30 or less on the MMSE indicates cognitive disturbance, but the MMSE does not distinguish delirium from dementia.  All possible causes should be considered.  Delirium symptoms tend to have sudden onset, but may be associated with any causes. POSSIBLE CAUSES  Fluid and electrolyte imbalances  Infection  Certain medications or Polypharmacy  Impaired cardiac or respiratory function  Emotional stress  Unfamiliar surroundings  Malnutrition  Anemia EVALUATING DELIRIUM  Dehydration  Alcoholism  Can be done using the  Hypoxia IN and OUT APPROACH DETECTION:  Delirium can be detected promptly by: - a good history & physical examination - MMSE - Confusion Assessment Method (CAM) -geriatric depression screening - laboratory test CBC, electrolytes, liver & renal function Glucose, urinalysis, Chest Xrays, ECG & O2 saturation  IN and OUT Approach: Wiesenfeld, 2008 1. Look at the IN and OUT of the brain. 2. What could have happened IN the brain to bring on the delirium (stroke, brain injury, infection such as meningitis). 3. What could have happened physiologically OUTSIDE of the brain (endocrine dysfunction, organ failure, UTI, dehydration, etc) 4. Next, evaluate what could have been taken IN by the patient (medications such as opiates, benzodiazapines, anticholinergics, steroids), 5. And what might be going on OUTside of the body (such as alcohol withdrawal, or withdrawal from any psychoactive medication such as antidepressants, sedatives, etc)