Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
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
Confusion Assessment Method and bCAM (brief version)
Test for delirium
Risk factors for delirium include :
Pre-existing cognitive impairment or dementia
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
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The Psychological Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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