of 13
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Delirium Definition
An acute disruption of attention and
cognition that has a tendency tofluctuate during the course of the day.
Foreman et al. (2001)
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The Experience of Delirium
trapped in incomprehensible experiencesand turmoil of past, present and here
and there, which are all regarded asreal and at the same time as changingand unreal
Andersson et al. (2002)
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Significance of Delirium
6-56% hospital incidence rate in elderly
14-24% of patients admitted delirious
25-61% of hip fracture patients
6 times greater mortality rates
increased length of hospital stay
increased intensity of nursing care more institutional placements
greater hospital costs
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Delirium Risk Factors
Predisposing Factors for Delirium (n=107)
Risk Factor Relative RiskVision Impairment 3.5 (1.2, 10.7)
Severe Illness 3.5 (1.5, 8.2)
Cognitive Impairment 2.8 (1.2, 6.7)
Inouye (1998)
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Delirium Risk Factors
Precipitating Factors for Delirium (n=196)
Precipitating Factor Relative Risk
Use of physical restraints 4.4 (2.5-7.9)
Malnutrition 4.0 (2.2-7.4)
>3 new medications 2.9 (1.6-5.4)
Use of bladder catheter 2.4 (1.2-4.7)Iatrogenic event 1.9 (1.1-3.2)
Inouye (1998)
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Delirium Risk Factors
Rate of delirium per day...
Predisposing and Precipitating FactorsPredisposing Precipitating Factors Group
Factors
Group Low Intermediate High
Low 0 0 0
Intermediate 0 3.2 13.6High 1.4 4.9 26.3
Inouye (1998)
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Prevention of Delirium
Inouye et al. (1999)
n= 852 medical inpatients
controlled prospective matching strategy
Intervention
Standardized protocol for the management of
cognitive impairment, sleep deprivation,immobility, visual/hearing impairment, anddehydration
Outcome
Incidence of delirium
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Prevention of Delirium
Significant reduction in incidence of delirium(9.9% vs 15%, odds ratio= 0.60, P=0.02)
Significant decreased # of delirium episodes (62vs 90)
Significant reduction in total # of days withdelirium (105 vs 161 days)
Costs of implementing were offset by care costsavings
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Prevention is the key!
Primary prevention of delirium is
probably the most effective treatmentstrategy
Inouye et al. (1999)
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Prevention of Delirium
Cognitive Impairment
orientation protocol
therapeutic activities
Sleep Deprivation
non-pharmacological sleep protocol
sleep enhancement protocol
Immobility early mobilization protocol
minimal use of immobilizing equipment
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Prevention of Delirium
Visual Impairment use of visual aids and adaptive equipment
Hearing Impairment use of amplifying devices
earwax disempaction
Dehydration
early recognition of dehydration
volume repletion
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Summary
Delirium is deleterious for the patient, health
care provider and health system Primary prevention may be the most effective
approach
Prevention strategies are feasible!
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Resources
Inouye et al. (1999). A multicomponent interventionto prevent delirium in hospitalized older patients.New England Journal of Medicine, 340(9), 669-676.
Inouye et al. (2000). The Hospital Elder LifeProgram: A model of care to prevent cognitive andfunctional decline in older hospitalized patients.Journal of the American Geriatrics Society, 48,1697-
1706. Hospital Elder Life Program
(www.info.med.yale.edu/intmed/elp/index.htm)
