Therapeutische Umschau. Revue thérapeutique
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The prevalence of delirium in the Intensive Care Unit (ICU) is reported to vary from 20 to 80 %. Delirium in the ICU is not only a frightening experience for the patient and his or her family, it is also a challenge for the nurses and physicians taking care of the patient. Furthermore, it is also associated with worse outcome, prolonged hospitalisation, increased costs, long-term cognitive impairment and higher mortality rates. ⋯ Key factors are the prevention and management of common risk factors, including avoiding overzealous sedation and analgesia and creating an environment that enhances reintegration. Once delirium is diagnosed, treatment consists of the use of typical and atypical antipsychotics. Haloperidol is still the drug of choice for the treatment of delirium and can be given intravenously in incremental doses of 1 to 2 to 5 (to 10) mg every 15 - 20 minutes.
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The prevalence of deliria is increasing exponentially with cumulative age. At the University Hospital of Basel 16 % of patients in the 70-79 year age-group, 27 % in the 80-89 year age-group and 39 % of the over 90 year old are rated as confused and disoriented. ⋯ In addition to the assessment of medication, laboratory parameters, oxygenation or urinary excretion, patient-oriented evaluations, pain and stress management, assessment of patient perception and communication are of particular importance. To meet these goals, nurses need knowledge, education and proof of clinical evidence.
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Delirium in the elderly is a transient, mostly reversible organic-mental syndrome with acute confusion, cognitive impairment, decline of vigilance, increased or reduced psychomotor activity and a disturbed sleep-wake-cycle. The etiology of delirium is multifactorial. The prevalence of delirium at hospital admission ranges from 14 to 24 percent. ⋯ Further, a close association between delirium and increased mortality rate has been documented. Unfortunately, if not specifically looked for, delirium often remains undiscovered by patients, physicians and nurses. Recent scientific work demonstrates the important effects of delirium both on an individual and societal level, as well as on the health-care system.