Delirium: Risk Factors, Contributors, Identification, Work-Up, and Treatment
Delirium is a common, serious, and life-threatening condition that is often missed and poorly managed. Increasing evidence argues that health-care providers need to assess the mental status of the patient as the “sixth vital sign.” Although functional neuroimaging and CSF biomarkers are being studied in delirium management, the diagnosis is a clinical one without a laboratory test or imaging to confirm it.
Delirium is associated with increased morbidity, mortality, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, increased cost of care, and prolonged hospital stays. Management includes the rapid identification of the cause(s), and correcting it/them if possible. Managing risk factors such as dehydration, infection, polypharmacy, immobility, restraints, and sensory impairment is key in both identifying the cause and reducing the consequences and optimizing patient care. This chapter will explore the identification, work-up, risk factors, and management of this important condition.
KeywordsDelirium Confusion Geriatric inpatient
- 1.Downing LJ, Caprio TV, Lyness JM. Geriatric psychiatry review: differential diagnosis and treatment of the 3 D’s – delirium, dementia, and depression. Curr Psychiatry Rep. 2013;15:365.Google Scholar
- 3.O’Sullivan R, Inouye SK, Meagher D. Delirium and depression: inter-relationship and overlap in elderly people. Lancet Psychiatry. 2014;1(4):303–11.Google Scholar
- 4.Hosker C, Ward D. Hypoactive delirium. BMJ. 2017;357:j2047.Google Scholar
- 5.Elie M, Rousseau F, Cole M, Primeau F, Mccusker J, Bellavance F. Prevalence and detection of delirium in elderly emergency department patients. CMAJ (Canadian Medical Association Journal = Journal De L’Association Medicale Canadienne). 2000;163(8):977–81.Google Scholar
- 7.Inouye SK, Marcantonio ER, Metzger ED. Doing damage in delirium: the hazards of antipsychotic treatment in elderly persons. Lancet Psychiatry. 2014;1(4):312–5.Google Scholar
- 15.American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington, VA, US: American Psychiatric Publishing, 2013.Google Scholar
- 21.Magny E, Le Petitcorps H, Pociumban M, Bouksani-Kacher Z, Pautas E, Belmin J, Lafuente-Lafuente C. Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: a prospective case series. PLoS One. 2018;13(2):E0193034.CrossRefGoogle Scholar
- 23.Porsteinsson AP, Drye LT, Pollock BG, Devanand DP, Frangakis C, Ismail Z, Marano C, Meinert CL, Mintzer JE, Munro CA, Pelton G, Rabins PV, Rosenberg PB, Schneider LS, Shade DM, Weintraub D, Yesavage J, Lyketsos CG, CitAD Research Group. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014;311(7):682–91.CrossRefGoogle Scholar
- 37.Girard TD, Exline MC, Carson SS, et al. Haloperidol and ziprasidone for treatment of delirium in critical illness. N Engl J Med. 2018;379(26):2506–16.Google Scholar