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
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).
Rapid assessment test for delirium and cognitive impairment
Short Confusion Assessment Method
Test for delirium
Delirium is one of 4 sub-domains of the
The Psychological Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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Back To : Psychological Assessment