Seniors and Delirium
05/01/11 10:32
Delirium is a common mental health disorder involving disturbances in consciousness, perception, thought and memory that primarily affects seniors. It is increasingly being recognized as a serious disorder with a potentially negative impact upon the quality of life of seniors. Delirium can be mistaken for, or exist alongside other, mental disorders, making assessment somewhat difficult.
Symptoms
Delirium is different from both dementia and depression in that the symptoms begin within a short period of time, hours or days. The symptoms may fluctuate over the day, so that the individual may only experience symptoms in one part of the day and be fine the rest of the time. The following symptoms are present in a person experiencing delirium:
Delirium is commonly found in hospitalized seniors; 10-15 percent are admitted to hospital with delirium, while an additional 15-25 percent develop the disorder following admission. Despite the significant numbers affected, from 32 to 67 percent of seniors with delirium are not diagnosed by doctors (Rudolph et al., 2003). It is unknown how many seniors living in the community are affected (McEwan, Donnelly, Robertson, & Hertzman, 1991).
Causes
A diagnosis of delirium requires the existence of a medical condition that can be determined to be the underlying cause. A variety of medical conditions, treatments and substances can cause delirium, including systemic infections, hypoglycema, the result of an operation for treatment of a medical condition, alcohol use, alcohol withdrawal, benzodiazepenes, antidepressants, antipsychotics and lithium (Rudolph et al., 2003). Seniors are more likely to be taking a variety of prescription and over-the-counter medications which can contribute to the risk of adverse outcomes such as delirium (MacCourt, Tuokko, & Tierney, 2000).
Assessment and Treatment
Assessment requires the ability to separate out the symptoms of delirium from other common mental disorders and recognize where delirium is present in addition to dementia or depression. Attention to the underlying medical disorder can help in the treatment of delirium. Ensuring quality care to the senior in the hospital such as ensuring that they receive proper food, water and sleep is beneficial (Rudolph et al., 2003). Supportive interventions can help the senior cope with their disorientation and confusion, such as reminding the individual where they are and why they are in the hospital. Antipsychotic medication can be used for the treatment of symptoms such as hallucinations and agitation (American Psychiatric Association, 1999).
Outcomes
Prevention is generally more successful than treatment once delirium has developed. Although delirium was once thought to be a short term concern, research has recently demonstrated that the symptoms may continue for up to 12 months after the problem is originally diagnosed (McCusker, 2003). Seniors who develop delirium appear to be at higher risk for developing dementia, greater risk of death and decreased likelihood of returning to their formal level of functioning. The moderate rate of success with prevention interventions and the increased long term risk to seniors who develop delirium highlight the need for proper recognition of this common disorder.
Original article: http://www.ontario.cmha.ca/seniors.aspcID=5803
Symptoms
Delirium is different from both dementia and depression in that the symptoms begin within a short period of time, hours or days. The symptoms may fluctuate over the day, so that the individual may only experience symptoms in one part of the day and be fine the rest of the time. The following symptoms are present in a person experiencing delirium:
- Inattention – the senior is not able to focus on a conversation, or is easily distracted by other things around them
- Disorganized thinking – speech may be rapid and/or incoherent
- Disorientation to time – the senior may think that morning is night
- Illusions or visual hallucinations - seeing things that aren't present or misinterpreting noises or situations
- Either agitation, or slowed-down physical movement, speech and drowsiness to the point of stupor, and/or alternating between the two extremes (Conn, 2002; Rudolph & Marcantonio, 2003)
Delirium is commonly found in hospitalized seniors; 10-15 percent are admitted to hospital with delirium, while an additional 15-25 percent develop the disorder following admission. Despite the significant numbers affected, from 32 to 67 percent of seniors with delirium are not diagnosed by doctors (Rudolph et al., 2003). It is unknown how many seniors living in the community are affected (McEwan, Donnelly, Robertson, & Hertzman, 1991).
Causes
A diagnosis of delirium requires the existence of a medical condition that can be determined to be the underlying cause. A variety of medical conditions, treatments and substances can cause delirium, including systemic infections, hypoglycema, the result of an operation for treatment of a medical condition, alcohol use, alcohol withdrawal, benzodiazepenes, antidepressants, antipsychotics and lithium (Rudolph et al., 2003). Seniors are more likely to be taking a variety of prescription and over-the-counter medications which can contribute to the risk of adverse outcomes such as delirium (MacCourt, Tuokko, & Tierney, 2000).
Assessment and Treatment
Assessment requires the ability to separate out the symptoms of delirium from other common mental disorders and recognize where delirium is present in addition to dementia or depression. Attention to the underlying medical disorder can help in the treatment of delirium. Ensuring quality care to the senior in the hospital such as ensuring that they receive proper food, water and sleep is beneficial (Rudolph et al., 2003). Supportive interventions can help the senior cope with their disorientation and confusion, such as reminding the individual where they are and why they are in the hospital. Antipsychotic medication can be used for the treatment of symptoms such as hallucinations and agitation (American Psychiatric Association, 1999).
Outcomes
Prevention is generally more successful than treatment once delirium has developed. Although delirium was once thought to be a short term concern, research has recently demonstrated that the symptoms may continue for up to 12 months after the problem is originally diagnosed (McCusker, 2003). Seniors who develop delirium appear to be at higher risk for developing dementia, greater risk of death and decreased likelihood of returning to their formal level of functioning. The moderate rate of success with prevention interventions and the increased long term risk to seniors who develop delirium highlight the need for proper recognition of this common disorder.
Original article: http://www.ontario.cmha.ca/seniors.aspcID=5803
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