Delerium

Question 1

What is delirium?

Answer 1

Delirium = acute change in mental state with the following key features

• Disturbed consciousness (hypoactive/hyperactive/mixed)
• Change in cognition (memory, perceptual, language, illusions, hallucinations)

Question 2

What are key and common features of delirium?

Answer 2

Delirium = acute change in mental state with the following key features

• Disturbed consciousness (hypoactive/hyperactive/mixed)
• Change in cognition (memory, perceptual, language, illusions, hallucinations)

Other common features:

• Disturbance of sleep wake cycle
• Disturbed psychomotor behaviour (affects physical function)
• Emotional disturbance

Question 3

What is the aetiology of delirium?

Answer 3

• Unknown

Question 4

Describe the epidemiology of delrium (age group. % of all patients)?

Answer 4

• More common in older people
• 20-30% all in patients

Question 5

What are risk factors for delirium?

Answer 5

• Frailty
• Can be precipitated by
  
  • Infection
  • Dehydration
  • Biochemical disturbances
  • Pain
  • Drugs
  • Urinary retention/constipation
  • Hypoxia
  • Alcohol/drug withdrawal
  • Sleep disturbance
  • Brain injury

Question 7

How is delirium diagnosed?

Answer 7

• 4AT form
  
  • Measures alertness, AMT4, attention, acute change or fluctuating course

Question 8

What investigations should be done for delirium?

Answer 8

• 4AT form
  
  • Measures alertness, AMT4, attention, acute change or fluctuating course
• TIME bundle
  
  • Assess and exclude possible triggers, investigate and intervene underlying causes, management plan, engage and explore
• Comprehensive geriatric assessment

Question 9

What is measured in a 4AT form?

Answer 9

• 4AT form
  
  • Measures alertness, AMT4, attention, acute change or fluctuating course

Question 10

Describe the management for delirium?

Answer 10

• Prevention measures
  
  • Orientation, promoting sleep hygiene, pain control, early mobilisation, hydration and nutrition, regulation of bowel and bladder function
• Non-pharmacological
  
  • Re-orientate and reassure
  • Encourage early mobility
  • Normalise sleep/wake cycle
  • Avoid frequent changes to wards/rooms
  • Discharge ASAP
• Pharmacological
  
  • Stop bad drugs if you can
  • No medications are proved to improve delirium
  • Maybe anti-psychotics if danger to themselves or others but decision by consultant

Question 11

What are possible complications of delirium?

Answer 11

• Massive morbidity and mortality
• Longer length of stay in hospital
• Increased rates of institutionalisation
• Persistent functional decline
• Psychological impact
• 4.5x more likely to have a fall

Question 12

Describe the prognosis of delirium?

Answer 12

• Usually settles quickly with management of underlying cause
• More likely to develop dementia
• Risk factor for further episodes of delirium

Question 13

What is the relationship between capacity and delirium?

Answer 13

In delirium, need to consider is the person capable of making decisions about their care or do they need a legally appointed proxy decision maker:

• Welfare POA or guardian

Question 14

How should UTIs be NOT diagnosed by in the elderly?

Answer 14

UTI is blamed too much for delirium – although it is a possible cause:

• Do not use dipstick tests for diagnosis of UTI in older people