Resources for the Comprehensive Geriatric Assessment based

Proactive and Personalised Primary Care of the Elderly

Delirium

Delirium is an acute confusional state, usually with a fluctuating course, characterised by disturbed consciousness, cognitive function or perception

4 A's Test

Rapid assessment test for delirium

3 min.

Confusion Assessment Method and bCAM (brief version)

Test for delirium

5-10 min.

Risk factors for delirium include :

• Age>65 years

• Pre-existing cognitive impairment or dementia

• Severe illness

• Current hip fracture

Delirium should be suspected in the presence of:

• An acute confusional state

• A change in perception e.g. visual or auditory hallucinations

• A change in physical function e.g. reduced mobility, agitation, sleep disturbance

• A change in social behaviour e.g. withdrawal, lack of co-operation for reasonable requests, alterations in mood, change in communication/attitude

Often patients may be labelled as "not themselves," "generally unwell," or "generally deteriorating." Even where patients do not meet all the criteria for a diagnosis of delirium, they may benefit from the approach to diagnosis and management outlined below, bearing in mind the other diagnoses that may be relevant to presentations such as reduced mobility.

Delirium is usually caused by a medical disorder, substance intoxication/withdrawal or medication side effect. In older people, especially those with pre-existing cognitive impairment, it is common to find several factors contributing to delirium.

PINCHES ME is a useful mnemonic for the review of possible causes for delirium :

• P - Pain

• I - Infection

• N - Nutrition

• C - Constipation

• H - Hydration

• E - Endocrine + Electrolyte

• S - Stroke

• M - medication and Alcohol

• E - Environmental

The onset of delirium is usually over hours to days and lasts for days to weeks, although longer periods have been reported.

The incidence of delirium in the community is 1-2 percent, although this rises to 14 percent in people over the age of 85.

In nursing homes, or post acute care settings, incidence is higher and may reach 60 percent (Inouye SK, 2006).

The cause for delirium in older people is usually multi-factorial.

Whereas young people who are not at risk of delirium may yet develop delirium if they are subject to enough insult e.g. major surgery, severe pain and use of multiple sedative/anaesthetic drugs on an intensive care unit, older people with pre-existing dementia may develop delirium if they are in pain or constipated or started on a new medication (although multiple contributing factors are commonly found).

Delirium is one of 4 sub-domains of the

Psychological Assessment

Back To : Psychological Assessment

The Psychological Assessment is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

Back To : Comprehensive Geriatric Assessment