Background

The Problem

The hospital environment is a different and challenging environment for older persons. It is this environment which often precipitates or exacerbates episodes of delirium and caring for this confused older person is challenging for all members of the health care team. Delirium is a major and frequent problem in older hospitalised people. This is primarily related to their increased susceptibility to disease and changes in the body's ability to metabolise drugs(10).

Delirium should be suspected in all cases of confusion in the older hospitalised person. What makes this so important is delirium can lead to poor outcomes however; early recognition and treatment of the cause can prevent or at least halt the risks associated with the disorder and lead to resolution of the delirium.

Delirium is usually fully reversible.

Importance of Early Recognition

Unrecognised delirium is a significant problem for health care facilities and patients. It is claimed in international reports that delirium is undiagnosed in up to 94% of older patients(11). Early recognition of delirium enables diagnosis and treatment of the underlying cause/sand can prevent poor negative outcomes (12). Additionally it is well recognised thatprevention of delirium is the best way to stop poor outcomes(13) and preventative strategies are most often the same as early management strategies(1).

Delirium: The impact

For the person with delirium:

Increased risks of falls, pressure sores, pneumonia, hospitalization, a decrease in functional capacity and dying(14,15).

For the family and significant others:

Distress and anxiety(16).

For health care facilities:

Increased costs associated with the increased hospitalization times, increased staffing requirements and other costs associated with medications, rehabilitation services, pathology and radiology(17-20).

Who gets delirious

• Baseline Vulnerability: e.g. cognitive impairment, visual impairment, severe illness, older age, plus
• Triggering event: e.g. narcotics, pain, dehydration, constipation, hypoxia, equals

Delirium

NB: The more risk factors present the lesser of an insult is required to develop a delirium