Delirium in the Elderly

Author: Steve Fordham / Editor: Clifford J Mann / Reviewer: Liz Florey, Mohamed Elwakil, Sandi Angus / Code: / Published: 14/08/2023

Delirium, or acute confusional state, is a common cause of attendance to an emergency department (ED). The high morbidity and mortality associated with this condition highlights the need for continuing review of the management of acutely-confused elderly patients.

After completing this session you will be able to:

  • Summarise the morbidity and mortality associated with acute confusion in the elderly
  • Outline, with examples, common presentations and precipitants
  • Propose and justify a structured, pragmatic approach to the investigation of the acutely-confused elderly patient
  • Explain how to implement appropriate treatment strategies, after considering a differential diagnosis
  • Highlight the pitfalls that may be encountered in the management of the acutely-confused elderly patient
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References

  1. British Geriatrics Society. SIGN 157: Risk reduction and management of delirium. Clinical guidelines. 2019.
  2. National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management in hospital and long-term care. NICE [CG103], 2010. Last updated: 18 Jan 2023.
  3. MacLullich AMJ, Shenkin SD, Goodacre S, et al. The 4 As test for detecting delirium in acute medical patients: a diagnostic accuracy study. Southampton (UK): NIHR Journals Library; 2019 Aug. (Health Technology Assessment, No. 23.40.) Chapter 1, General introduction.
  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edn. Washington, DC: American Psychiatric Association; 2013.
  5. Hustey FM, Meldon SW. The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med. 2002 Mar;39(3):248-53.
  6. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb;75(2):136-145.
  7. Rapid Clinical Test for Delirium 4AT
  8. British Geriatrics Society. 14. CGA in Primary Care Settings: Patients presenting with confusion and delirium. Good Practice Guide, 2019.
  9. Delirium. Royal College of Psychiatrists (RCPsych) Public Engagement Editorial Board, 2019.
  10. Young J, Inouye SK. Delirium in older people. BMJ. 2007 Apr 21;334(7598):842-6.
  11. Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons. Arch Intern Med. 2008;168(5):508513.
  12. Lonergan E, Mehta S, et al. Antipsychotics to treat delirium in hospitalised patients. Cochrane Database of Systematic Reviews 2018, Issue 6. Art. No.: CD005594.
  13. D’Souza RS, Hooten WM. Extrapyramidal Symptoms. [Updated 2023 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
  14. Siddiqui, N, Harrison JK, et al. Interventions to prevent delirium in hospitalised patients. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD005563.
  15. Mohr E, Mendis T, Hildebrand K, De Deyn PP. Risperidone in the treatment of dopamine-induced psychosis in Parkinson’s disease: an open pilot trial. Mov Disord. 2000 Nov;15(6):1230-7.

Further Reading

Please refer to the following websites for more information:

  • British Geriatrics Society and Royal college of Physicians National Guidelines: The prevention, diagnosis and management of delirium in older people, 2006. View link

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