Management of Elderly Patients with Delirium Syndrome

Abstract

Delirium is defined as an acute disturbance in attention and cognition which develops over a short period of time. Delirium is the most common complication afflicting hospitalized patients ages 65 and older even if it often remains unrecognized; this is particularly true if the mental status at the base line is neglected. In addition to the DSM V Manual, the most widely used instrument worldwide is the algorithm of the CAM. Another useful test is the 4AT which is sensitive to detect a hypokinetic subtype. The development of delirium involves a complex interrelationship between multiple predisposing factors that make an older patient more vulnerable to noxae and precipitating factors. When elderly patients arrive at the hospital, we should do a screening for risk factors such as age 65 years or older, current hip fracture, cognitive impairment or dementia, and severe illness. At this point we can start to prevent delirium using a nonpharmacological approach, with a multidisciplinary equip and an intensive follow-up. When delirium occurs, it’s important to investigate and treat the clinical underlying causes as well as continue the nursing management, involving caregivers, physiotherapists for early mobilization, occupational therapists for cognitive stimulation and environmental measures. Pharmacological intervention has to be considered when adults with delirium are distressed or considered a risk to themselves or others, when nonpharmacological techniques have been ineffective. Indications to start neuroleptic medication at the lowest appropriate dose according to symptoms and for as short time as possible.