Skip to main content

Delirium in Older Adults: Practical Guide for Primary Health Services

  • Chapter
  • First Online:
Primary Care Mental Health in Older People

Abstract

Delirium is a common and serious acute neuropsychiatric syndrome and is known to increase the risk for subsequent functional decline and mortality. The etiologies of delirium are diverse and multifactorial and often reflect the pathophysiological consequences of an acute medical illness, medical complication or drug intoxication. Delirium can have a widely variable presentation and is often missed and underdiagnosed as a result. At this chapter we discuss the prediction, etiology, prevention, diagnosis, subtypes and treatment (pharmacological and non-pharmacological) of delirium in the elderly population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med. 1999;106(5):565–73.

    Article  CAS  Google Scholar 

  2. McCusker J, et al. Environmental risk factors for delirium in hospitalized older people. J Am Geriatr Soc. 2001;49(10):1327–34.

    Article  CAS  Google Scholar 

  3. Jorge-Ripper C, et al. Prognostic value of acute delirium recovery in older adults. Geriatr Gerontol Int. 2016;17(8):1161–7.

    Article  Google Scholar 

  4. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210–20.

    Article  Google Scholar 

  5. Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc. 2011;5:S241–3.

    Article  Google Scholar 

  6. Bellelli G, et al. Under-detection of delirium and impact of neurocognitive deficits on in-hospital mortality among acute geriatric and medical wards. Eur J Intern Med. 2015;26(9):696–704.

    Article  CAS  Google Scholar 

  7. Gustafson Y, et al. Depression in old age in Austria, Ireland, Portugal and Sweden. Eur Geriatr Med. 2013;4(3):202–8.

    Article  Google Scholar 

  8. Brown T, Boyle M. Delirium. Br Med J. 2002;325(7365):644.

    Article  CAS  Google Scholar 

  9. Kalish VB, Gillham JE, Unwin BK. Delirium in older persons: evaluation and management. Am Fam Physician. 2014;90(3):150–8.

    PubMed  Google Scholar 

  10. Bellelli G, et al. “Delirium Day”: a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med. 2016;14(1):106.

    Article  Google Scholar 

  11. Cavallari M, et al. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI. Brain. 2016;139(Pt 4):1282–94.

    Article  Google Scholar 

  12. Cerejeira J, et al. Low preoperative plasma cholinesterase activity as a risk marker of postoperative delirium in elderly patients. Age Ageing. 2011;40(5):621–6.

    Article  Google Scholar 

  13. Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. The immunology of delirium. Neuroimmunomodulation. 2014;21(2–3):72–8.

    Article  CAS  Google Scholar 

  14. Trzepacz P, et al. Treatment of patients with delirium. In: A.P. Association, editor. Practice Guidelines for the treatment of Psychatric Disorders. Arlington: American Psychiatric Association; 2006. p. 71.

    Google Scholar 

  15. Lipowski Z. Delirium (acute confusional states). JAMA. 1987;258(13):1789–92.

    Article  CAS  Google Scholar 

  16. Hogg J. Delirium. In: Robert Jacoby CO, Dening T, Thomas A, editors. Oxford textbook of old age psychiatry. New York: Oxford University Press; 2008. p. 505–17.

    Google Scholar 

  17. Leonard M, et al. Phenomenological and neuropsychological profile across motor variants of delirium in a palliative-care unit. J Neuropsychiatry Clin Neurosci. 2011;23(2):180–8.

    Article  Google Scholar 

  18. Diana Rafaela JC. Delirium. In: Horácio Firmino MRS, Cerejeira J, editors. Saude mental das pessoas mais velhas, vol. 291-304. Coimbra: LIDEL; 2016.

    Google Scholar 

  19. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275(11):852–7.

    Article  CAS  Google Scholar 

  20. Cerejeira J, et al. The cholinergic system and inflammation: common pathways in delirium pathophysiology. J Am Geriatr Soc. 2012;60(4):669–75.

    Article  Google Scholar 

  21. Nogueira V, et al. Improving quality of care: focus on liaison old age psychiatry. Ment Health Fam Med. 2013;10(3):153.

    PubMed  PubMed Central  Google Scholar 

  22. Inouye SK, et al. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8.

    Article  CAS  Google Scholar 

  23. Ely EW, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–9.

    Article  CAS  Google Scholar 

  24. Grover S, Kate N. Assessment scales for delirium: A review. WJP. 2012;2(4):58–70.

    Article  Google Scholar 

  25. Fong TG, et al. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823–32.

    Article  Google Scholar 

  26. Panel TAGSE. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220(2):136–148. e1.

    Article  Google Scholar 

  27. Holt R, Young J, Heseltine D. Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age Ageing. 2013;42(6):721–7.

    Article  Google Scholar 

  28. Heymann A, et al. Delayed treatment of delirium increases mortality rate in intensive care unit patients. J Int Med Res. 2010;38(5):1584–95.

    Article  CAS  Google Scholar 

  29. Michaud CJ, Thomas WL, McAllen KJ. early pharmacological treatment of delirium may reduce physical restraint use a retrospective study. Ann Pharmacother. 2013;48(3):328–34.

    Article  Google Scholar 

  30. Morandi A, et al. Consensus and variations in opinions on delirium care: a survey of European delirium specialists. Int Psychogeriatr. 2013;25(12):2067–75.

    Article  CAS  Google Scholar 

  31. Seitz DP, Gill SS, van Zyl LT. Antipsychotics in the treatment of delirium: a systematic review. J Clin Psychiatry. 2007;68(1):11–21.

    Article  CAS  Google Scholar 

  32. Kishi T, et al. Antipsychotic medications for the treatment of delirium: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry. 2015;87(7):767–74.

    Article  Google Scholar 

  33. Hakim SM, Othman AI, Naoum DO. Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly a randomized trial. J Am Soc Anesthesiol. 2012;116(5):987–97.

    Article  CAS  Google Scholar 

  34. Youn YC, et al. Rivastigmine patch reduces the incidence of postoperative delirium in older patients with cognitive impairment. Int J Geriatr Psychiatry. 2016;32(10):1079–84. https://doi.org/10.1002/gps.4569.

    Article  PubMed  Google Scholar 

  35. Myrick H, Malcolm R, Brady KT. Gabapentin treatment of alcohol withdrawal. Am J Psychiatr. 1998;155(11):1626j–1626.

    Article  Google Scholar 

  36. Mackinnon GL, Parker WA. Benzodiazepine withdrawal syndrome: a literature review and evaluation. Am J Drug Alcohol Abuse. 1982;9(1):19–33.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Coroa, M., Firmino, H., Nogueira, V., Santiago, L.M. (2019). Delirium in Older Adults: Practical Guide for Primary Health Services. In: de Mendonça Lima, C., Ivbijaro, G. (eds) Primary Care Mental Health in Older People. Springer, Cham. https://doi.org/10.1007/978-3-030-10814-4_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-10814-4_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10812-0

  • Online ISBN: 978-3-030-10814-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics