Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-22T08:17:26.379Z Has data issue: false hasContentIssue false

Chapter 11 - Liaison Old Age Psychiatry Management of Delirium in Acute Hospitals

Published online by Cambridge University Press:  04 April 2024

By
Mani Santhana Krishnan ,
Josie Jenkinson  and
Rashi Negi
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
Get access

Summary

Delirium is an acute change in mental state causing difficulties in attention, awareness, and arousal, and also fluctuating cognition. There are often multiple underlying causes. Delirium is much more common in older people and affects approximately one in three elderly patients in acute hospitals (1). The presentation is often under-recognised throughout the patient’s journey, despite being associated with poor outcomes, higher costs of care, and higher mortality (2, 3). Delirium can be hyperactive (predominantly agitated), hypoactive (predominantly withdrawn and drowsy), or mixed.

Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 140 - 156
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fuchs, S., Bode, L., Ernst, J., Marquetand, J., von Känel, R., and Böttger, S. Delirium in elderly patients: Prospective prevalence across hospital services. Gen Hosp Psychiatry 2020, 67: 19–25.CrossRefGoogle ScholarPubMed
Leslie, D.L., Marcantonio, E.R., Zhang, Y., Leo-Summers, L., and Inouye, S.K. One-year health care costs associated with delirium in the elderly population. Arch Intern Med 2008, 168(1): 27–32.CrossRefGoogle ScholarPubMed
McCusker, J., Cole, M., Abrahamowicz, M., Primeau, F., and Belzile, E. Delirium Predicts 12-Month Mortality. Arch Intern Med 2002, 162(4): 457.CrossRefGoogle ScholarPubMed
Olofsson, B., Lundström, M., Borssén, B., Nyberg, L., and Gustafson, Y. Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures. Scand J Caring Sci 2005, 19(2): 119–27.CrossRefGoogle ScholarPubMed
Vasilevskis, E.E., Han, J.H., Hughes, C.G., and Ely, E.W. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol 2012, 26(3): 277–87.CrossRefGoogle ScholarPubMed
Flinn, D.R., Diehl, K.M., Seyfried, L.S., and Malani, P.N. Prevention, diagnosis, and management of postoperative delirium in older adults. J Am Coll Surg 2009, 209(2): 261–8; quiz 294.CrossRefGoogle ScholarPubMed
Barron, E.A., and Holmes, J. Delirium within the emergency care setting, occurrence and detection: a systematic review. Emergency Medicine Journal 2013, 30(4).CrossRefGoogle ScholarPubMed
Laurila, J.V., Pitkala, J.H., Strandberg, T.E., and Tilvis, R.S. The impact of different diagnostic criteria on prevalence rates of delirium. Dementia and Geriatric Cognitive Disorders 2003, 16(3).CrossRefGoogle Scholar
La Mantia, M.A., Messina, F.C., Hobgood, C.D., and Miller, D.K. Screening for Delirium in the emergency department: A systematic review. Annals of Emergency Medicine 2014, 63(5): 551–60.Google ScholarPubMed
Neto, A.S., Nassar, A.P., Cardoso, S.O., Manetta, J.A., Pereira, V.G.M., Esposito, D.C., Damasceno, M.C.T., and Slooter, A.J. Delirium screening in critically ill patients: A systematic review and meta-analysis. Critical Care Medicine 2012, 40(5): 1946–51.CrossRefGoogle ScholarPubMed
Bellelli, G., Morandi, A., Davis, D.H.J., Mazzola, M., Turco, R., Gentile, S., Ryan, T., Cash, H., Guerini, F., Torpilliesi, T., Del Santo, F., Trabucchi, M., Annoni, G., and MacLullich, A.M.J. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and Ageing 2014, 43(4): 496–502.CrossRefGoogle ScholarPubMed
Sands, M.B., Dantoc, B.P., Hartshorn, A., Ryan, C.J., and Lujic, S. Single Question in Delirium (SQiD): Testing its efficacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Palliative Care 2010, 24(6).Google ScholarPubMed
Inouye, S.K., van Dyck, C.H., Alessi, C.A., Balkin, S., Siegal, A.P., and Horwitz, R.I. Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990, 113(12): 941–8.CrossRefGoogle Scholar
The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium. Scottish Intercollegiate Guidelines Network. Medicina (Kaunas) 2019, 55(8): 491. doi: 10.3390/medicina55080491.CrossRefGoogle Scholar
Crowther, G.J.E., Brennan, C.A., and Bennett, M.I. The barriers and facilitators for recognising distress in people with severe dementia on general hospital wards. Age Ageing 2018, 47(3): 458–65.CrossRefGoogle ScholarPubMed
Kakuma, R., du Fort, G.G., Arsenault, L., Perrault, A., Platt, R.W., Monette, J. et al. Delirium in older emergency department patients discharged home: Effect on survival. J Am Geriatr Soc 2003, 51(4): 443–50.CrossRefGoogle ScholarPubMed
Siddiqi, N., House, A.O., and Holmes, J.D. Occurrence and outcome of delirium in medical in-patients: A systematic literature review. Age Ageing 2006, 35(4): 350–64.CrossRefGoogle ScholarPubMed
De Jonghe, J.F.M., Kalisvaart, K.J., Dijkstra, M., van Dis, H., Vreeswijk, R., Kat, M.G. et al. Early symptoms in the prodromal phase of delirium: A prospective cohort study in elderly patients undergoing hip surgery. Am J Geriatr Psychiatry 2007, 15(2): 112–21.CrossRefGoogle ScholarPubMed
Chuen, V.L., Chan, A.C.H., Ma, J., Alibhai, S.M.H., and Chau, V. Assessing the Accuracy of International Classification of Diseases (ICD) Coding for Delirium. J Appl Gerontol 2022, 41(5): 1485–90.CrossRefGoogle ScholarPubMed
Mariz, J., Costa Castanho, T., Teixeira, J., Sousa, N., and Correia Santos, N. Delirium diagnostic and screening instruments in the emergency department: An up-to-date systematic review. Geriatrics 2016, 1(3): 22.CrossRefGoogle ScholarPubMed
Grossmann, F.F., Hasemann, W., Graber, A., Bingisser, R., Kressig, R.W., and Nickel, C.H. Screening, detection and management of delirium in the emergency department: A pilot study on the feasibility of a new algorithm for use in older emergency department patients: The modified Confusion Assessment Method for the Emergency Department (mCAM-ED). Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22(1): 19.CrossRefGoogle Scholar
Ely, E.W., Inouye, S.K., Bernard, G.R., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., Hart, R.P., and Dittus, R. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU) J Am Med Assoc 2001, 286: 2703–10.CrossRefGoogle ScholarPubMed
Han, J.H., Wilson, A., Vasilevskis, E.E., Shintani, A., Schnelle, J.F., Dittus, R.S., Graves, A.J., Storrow, A.B., Shuster, J., and Ely, E.W. Diagnosing delirium in older emergency department patients: Validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med 2013, 62(5): 457–65.CrossRefGoogle ScholarPubMed
Neelon, V.J., Champagne, M.T., Carlson, J.R., and Funk, S.G. The NEECHAM Confusion Scale: Construction, validation, and clinical testing. Nurs Res 1996, 45(6): 324–30.CrossRefGoogle ScholarPubMed
Ely, E.W., Truman, B., Shintani, A., Thomason, J.W.W., Wheeler, A.P., Gordon, S., Francis, J., Speroff, T., Gautam, S., Margolin, R. et al. Monitoring sedation status over time in ICU patients: The reliability and validity of the Richmond Agitation Sedation Scale (RASS). J Am Med Assoc 2003, 289: 2983–991.CrossRefGoogle Scholar
Hall, R.J., Meagher, D.J., and MacLullich, A.M.J. Delirium detection and monitoring outside the ICU. Best Pract Res Clin Anaesthesiol 2012, 26(3): 367–83.CrossRefGoogle ScholarPubMed
Tieges, Z., Lowrey, J., and MacLullich, A.M.J. What delirium detection tools are used in routine clinical practice in the United Kingdom? Survey results from 91% of acute healthcare organisations. Eur Geriatr Med 2021, 12(6): 1293–8.CrossRefGoogle ScholarPubMed
Tieges, Z., Maclullich, A.M.J., Anand, A., Brookes, C., Cassarino, M., O’Connor, M. et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: Systematic review and meta-analysis. Age Ageing 2021, 50(3): 733–43.CrossRefGoogle ScholarPubMed
Bauernfreund, Y., Butler, M., Ragavan, S., and Sampson, E.L. TIME to think about delirium: Improving detection and management on the acute medical unit. BMJ Open Qual 2018, 7(3).Google Scholar
De, J., and Wand, A.P.F. Delirium screening: A systematic review of delirium screening tools in hospitalized patients. Gerontologist 2015, 55(6): 1079–99.CrossRefGoogle ScholarPubMed
Zivkovic, S., Koh, C.H., Kaza, N., and Jackson, C.A. Antipsychotic drug use and risk of stroke and myocardial infarction: A systematic review and meta-analysis. BMC Psychiatry 2019, 19(1): 189.CrossRefGoogle ScholarPubMed
MacSweeney, R., Barber, V., Page, V., Ely, E.W., Perkins, G.D., Young, J.D. et al. A national survey of the management of delirium in UK intensive care units. QJM 2010, 103(4): 243–51.Google Scholar
Wang, W., Li, H.L., Wang, D.X., Zhu, X., Li, S.L., Yao, G.Q. et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery. Crit Care Med 2012, 40(3): 731–9.CrossRefGoogle ScholarPubMed
NICE. Delirium: prevention, diagnosis and management in hospital and long-term care. Clinical guideline [CG103], 28 July 2010.Google Scholar
Larsen, K.A., Kelly, S.E., Stern, T.A., Bode, R.H., Price, L.L., Hunter, D.J. et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: A randomized, controlled trial. Psychosomatics 2010, 51(5): 409–18.CrossRefGoogle ScholarPubMed
Prakanrattana, U., and Prapaitrakool, S. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 2007, 35(5): 714–9.CrossRefGoogle ScholarPubMed
Mowat, D., Fowlie, D., and MacEwan, T. CSM warning on atypical psychotics and stroke may be detrimental for dementia. BMJ 2004, 328(7450): 1262.CrossRefGoogle ScholarPubMed
McKeith, I., del Ser, T., Spano, P., Emre, M., Wesnes, K., Anand, R. et al. Efficacy of rivastigmine in dementia with Lewy bodies: A randomised, double-blind, placebo-controlled international study. The Lancet 2000, 356(9247): 2031–6.CrossRefGoogle ScholarPubMed
Jackson, T.A., MacLullich, A.M.J., Gladman, J.R.F., Lord, J.M., and Sheehan, B. Undiagnosed long-term cognitive impairment in acutely hospitalised older medical patients with delirium: A prospective cohort study. Age Ageing 2016, 45(4): 493–9.Google ScholarPubMed
Jorm, A.F., and Jacomb, P.A. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Socio-demographic correlates, reliability, validity and some norms. Psychol Med 1989, 19(4): 1015–22.CrossRefGoogle ScholarPubMed
Richardson, S.J., Davis, D.H.J., Stephan, B.C.M., Robinson, L., Brayne, C., Barnes, L.E. et al. Recurrent delirium over 12 months predicts dementia: Results of the Delirium and Cognitive Impact in Dementia (DECIDE) study. Age Ageing 2021, 50(3): 914–20.CrossRefGoogle ScholarPubMed
Tauro, R. Delirium awareness: Improving recognition and management through education and use of a care pathway. BMJ Qual Improv Rep 2014, 2(2).CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×