Revista española de geriatría y gerontología
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The incidence of delirium in the elderly in general hospitals is up to 20 to 65%. Delirium is associated with high mortality, increased morbidity, increased need for nursing surveillance, longer hospital stays and a high rate of institutionalization following discharge. Delirium is not recognized by clinicians in one- to two-thirds of all cases and is commonly overlooked or misattributed to dementia, depression, or senescence; confusional states in the hospitalized elderly are considered the rule, rather than the exception and cognitive function is rarely assessed. ⋯ Also should the medical and nursing staff be made aware of prodromal symptoms for delirium, indicating a delirium is developing. Prevention requires multidisciplinary action with pharmacological and non pharmacological interventions (multifactor intervention). A pro-active consultation team (doctors and nurses) resulting in good basic medical- and nursing care have the best results concerning the prevention of delirium, reducing delirium incidence with more than 25%.
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Delirium is a highly prevalent geriatric syndrome, whose therapeutic management is complex due to the interaction of multiple possible causes in predisposed individuals. Treatment should be etiologic, aiming to treat the cause of the delirium. ⋯ We present the distinct options that should be considered in an individually-tailored, multidisciplinary care plan, in which physicians, nurses, therapists, physiotherapists and social workers collaborate to improve quality of life in the elderly patient with delirium. We review the modifications to the environment (design of a daily routine, sleep hygiene, physical exercise and leisure activity during the day) required in patients with delirium.
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The physiopathology of delirium has still not been characterized in depth, although this entity can be defined as a functional brain disorder provoked by one or multiple organic causes that display a common clinical syndrome. Certain specific brain regions that are involved in delirium have been identified, such as the prefrontal cortex, the thalamus and the basal ganglia, especially in the nondominant hemisphere. Functional changes occur in a large number of neurotransmitters: the most frequent and best characterized are a reduction of cholinergic function and an increase in dopaminergic and gabaergic function, although alterations in almost all neurotransmitter systems (serotoninergic, noradrenergic, glutaminergic, histaminergic) have been found. ⋯ Delirium in the elderly typically has a multifactorial etiology, with several simultaneous or sequential causes. Numerous risk factors have been described, both predisposing individuals to delirium and triggering this syndrome. Knowledge of these factors and their interactions is of great clinical importance and consequently etiologic diagnosis should be based on a multifactorial model.
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Rev Esp Geriatr Gerontol · Jan 2008
Review[Delirium in older patients: clinical presentation and diagnosis].
Delirium is a mental disorder characterized by acute onset, fluctuating course and disturbances in consciousness, orientation, memory, thought, perception and behavior. This disorder occurs in hyperactive, hypoactive or mixed forms in up to 50% of older hospital inpatients, many with pre-existing dementia, and is independently associated with poor outcomes. ⋯ The use of protocols to identify patients at high risk of delirium, systematic assessment of mental status in all older inpatients by healthcare professionals and the use of DSM-IV criteria may improve detection and diagnosis. Similar strategies may improve the detection and diagnosis of subsyndromal delirium.
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Rev Esp Geriatr Gerontol · Jan 2008
Review[Delirium: a marker of health status in the geriatric patient].
Delirium is defined as a syndrome characterized by an acute and fluctuating decline in higher cognitive functions. The impact of this syndrome is often underestimated in the geriatric population both from the diagnostic and prognostic points of view. ⋯ Likewise, the impact of delirium on the health system (increases in hospital stay, referrals and costs) is discussed. Therefore, we propose that delirium be considered as a marker of health status, which would allow assessment of this syndrome to be broadened to include two fundamental considerations: firstly, that persons with delirium belong to a group with a higher risk of adverse events and secondly, that delirium is a marker of health status, which would allow the quality of health services that manage elderly patients to be evaluated, given that delirium is partly preventable and its management is multidisciplinary and complex.