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- Despite medical progress, delirium remains a major challenge for health care workers with the increasing burden of an ageing population.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3282320/Delirium in the Elderly: A Review - PMC - National Center for ...
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Delirium: a major diagnostic and therapeutic challenge for clinicians caring for the elderly. Compr Ther. 1994;20 (10):550-7. Authors. S E Levkoff 1 , E R Marcantonio. Affiliation. 1 Division on Aging, Harvard Medical School, Boston, Massachusetts 02115. PMID: 7859437. Publication types. Research Support, U.S. Gov't, P.H.S. Review. MeSH terms.
- Delirium in Older Persons: Advances in Diagnosis and Treatment
Rates of unrecognized delirium, defined as delirium...
- A Clinical Update on Delirium: From Early Recognition to ...
Delirium is a common occurrence in medical or surgical wards...
- Delirium in Older Persons: Advances in Diagnosis and Treatment
Rates of unrecognized delirium, defined as delirium diagnosed by an expert assessor after the diagnosis was not made by the patient’s treating physicians and nurses, ranged from 55% to 70% in 2000–2001 2, 3 and still remain around 60% in 2015. 4 Delirium is a complex and challenging condition, and a synthesis of current evidence should optimize clinical care. The goals of this review were ...
- Key Points
- Introduction
- Recognition and Relief of Distress in Delirium
- New Directions For Delirium Epidemiology
- Towards Better Research-Grade Assessment of Delirium
- Conclusions
- Declaration of Funding
- Declaration of Conflicts of Interest
Progress in delirium care is accelerating, with a tripling of research outputs and many policy advances in the last decade.Yet multiple scientific and clinical practices challenges remain; here, we highlight three key areas.Distress is often missed in delirium; advances in practice and research have huge potential to improve care.New epidemiological study designs capturing pre-, intra- and post-delirium status are providing key new insights.There may be no other acute medical condition with the range of challenges that delirium currently presents. It affects one in four older hospitalised adults, is linked with at least an 8-fold risk of future dementia, causes significant distress in patients and carers, and greatly increases the risk of mortality and other complications [1, 2]. Desp...
Distress as a serious complication of delirium
We have long known that delirium often causes distress (from the Latin distringere, to ‘stretch apart’) for the affected person, their family and clinicians. Patients who experienced delirium in hospital have reported feeling frightened, anxious, perplexed, helpless, frustrated, disconnected or lonely during delirium, and afterwards, ashamed, guilty and fearful of its return [10, 11]. Family members and clinicians also experience distress and communication challenges in response to delirium [...
Research gap: treating distress in delirium
Given the consistency of research and anecdotal evidence that delirium is often profoundly distressing, it is remarkable how underevolved is the development of therapeutic clinical responses to distress. A factor in this neglect of distress as a specific therapeutic target may be the decades-long widespread and even routine practice of using psychotropic drugs as an attempted intervention for delirium and its symptoms, including distress . That is, the implicit assumption that drugs are e...
Developing non-pharmacological approaches to the management of distress in delirium
Fortunately, the failure to consider distress as a research topic will likely soon shift, because ‘emotional distress’ is included in new core outcome sets for delirium intervention trials [24, 25]. Developing a precise definition and measures for this outcome will be challenging, however. Firstly because, as noted above, delirium almost always occurs amidst myriad other sufferings. Secondly, delirium-related distress is not only experienced emotionally but also cognitively, physically, relat...
Epidemiology systematically describes what happens to whom, where and when. Early cross-sectional studies made clear that delirium was prevalent at scale in places of high acuity and frailty . Even so, contemporary delirium prevalence estimates continue to surprise , which has implications for the degree to which delirium remains underdetected in m...
Delirium is a complex syndrome which has multiple domains and parameters that can potentially be measured (Table 1) . Perhaps as a consequence, the field lacks agreed methods for research-grade assessment of delirium: in fact a strikingly disparate assortment of methods is used across studies . The result of this is divergent occurrence and prognos...
We have highlighted three related areas with promise in delirium practice and knowledge: distress, epidemiology and research assessment. There are however many other topics in the field with similarly exciting potential to influence clinical care and research. These include mandating delirium education , incorporating common outcomes including pati...
Z.T. is supported by the Dunhill Medical Trust (grant reference: RPGF1902\147). D.D. is supported by the Wellcome Trust through a fellowship award (WT107467) and through Medical Research Council Unit for Lifelong Health and Ageing at University College London (MC_UU_00019/1).
A.M. is the main author of the 4AT (see www.the4AT.com); there is no financial conflict of interest. A.M. was co-chair of the committee that produced the 2019 Scottish Intercollegiate Guidelines Network (SIGN) Guideline on Delirium in which the 4AT is recommended. A.M. and Z.T. co-developed the DelApp test of inattention; there are no financial con...
Sep 8, 2023 · Clinical trials investigating cholinesterase inhibitors in surgical patients, including rivastigmine and donepezil, have not demonstrated a reduction in the incidence of delirium after elective total major joint-replacement surgery, 27,28 surgery for hip fracture, 15 or elective cardiopulmonary bypass surgery. 29 A 2013 systematic review and ...
Overview. This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset.
Jun 16, 2011 · Delirium is a common occurrence in medical or surgical wards and affects particularly elderly people with comorbidities and prior cognitive impairment. Thus, this syndrome affects 11–42% of medically ill patients [3] and complicates 24–89% of hospitalizations for elderly patients with dementia [4].
Jul 28, 2010 · When people first present to hospital or long term care, assess them for the presence of the following risk factors for delirium: -Age 65 years or older -Cognitive impairment (past or present), dementia, or both. 3 If cognitive impairment is suspected, confirm it using a standardised and validated cognitive impairment measure, such as the mini ...
