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The US Geriatric Psychiatry Approach to Delirium

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Delirium in Elderly Patients

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Abstract

Delirium is frequent among elderly patients, characterized by acute confusion, with alteration of consciousness, and inability to focus and sustain attention. It is frequently underdiagnosed and causes a large burden on the patient, family, caregivers, healthcare systems, and care facilities. It is a dangerous condition that has traditionally been thought of as reversible if the causative agent is identified and treated. It can, however, be quite prolonged and associated with the progression of dementia, increased cerebral atrophy, increased healthcare costs, and mortality. A low threshold of suspicion for its presence and multidisciplinary modes for treatment can help reduce its progression and can help restore a patient’s cognitive equilibrium. It is important to have multimodal treatment initiated as early as possible. Treatments include calm surroundings, reorientation aids, improved sleep patterns, cognitive stimulation from staff and family, and removing potential offending medications. Use of psychoactive medications may also provide additional symptom relief while searching for and treating any underlying conditions which may have precipitated delirium. If pain is suspected, scheduled treatment with non-opioids to the maximum extent and then judicious use of scheduled analgesics is warranted with awareness that opioids can contribute to delirium.

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Authors and Affiliations

  1. Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA

    Neil Evans

  2. Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA

    George T. Grossberg

  3. Division of Geriatric Medicine, Dementia, Healthy Aging, St. Louis University School of Medicine, St. Louis, MO, USA

    George T. Grossberg

  4. Department of Anatomy and Neurobiology, St. Louis University School of Medicine, St. Louis, MO, USA

    George T. Grossberg

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Correspondence to George T. Grossberg .

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  1. Department of Geriatric Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey

    Ahmet Turan Isik

  2. Department of Neurology and Psychiatry, Saint Louis University, School of Medicine, St. Louis, MO, USA

    George T. Grossberg

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Evans, N., Grossberg, G.T. (2018). The US Geriatric Psychiatry Approach to Delirium. In: Isik, A., Grossberg, G. (eds) Delirium in Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-65239-9_6

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