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Delirium facts and figures

Delirium facts and figures. Daniel Davis. Senior Clinical Researcher Consultant in Geriatric Medicine University College London Dementia Friendly Hospitals Dementia Action Alliance 24 th November 2015. Overview. What is delirium Why is it important How to diagnose delirium

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Delirium facts and figures

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  1. Deliriumfacts and figures Daniel Davis Senior Clinical Researcher Consultant in Geriatric Medicine University College London Dementia Friendly Hospitals Dementia Action Alliance 24th November 2015

  2. Overview • What is delirium • Why is it important • How to diagnose delirium • How to manage delirium

  3. What is delirium?

  4. A neuropsychiatric syndrome DSM-IV: • Disturbance of consciousness • Change in cognition • Acute • Physiological precipitant Cognitive decompensation under stress conditions

  5. Normal function Range of abnormalities of cognition: quantifiable Range of abnormalities of level of arousal Range of delirium severity ‘Untestable’ with most cognitive tests Coma

  6. Subtype Hyperactive Wandering, aggressive Hyper-alert, agitated Strong Difficult to reason with Pulling at lines Easily recognised Often medicated Hypoactive Quiet, bewildered Sleepy, innattenitve “off-legs” Highest mortality – HR 1.6 Most often unrecognised More common Mixed Geront Series A: 2007; 62: 174-179

  7. Why does delirium matter?

  8. Why delirium matters Common 15% hospital Serious 20% mortality Marker for dementia 60% underlying Costly £13k / admission Distressing

  9. Diagnosis and management

  10. Action plan • Diagnose • Precipitating and predisposing • Optimise environment • Treat specific symptoms

  11. Initial approach [1] Assess arousal [2] Test cognition [3] Acute onset and/or fluctuating course?

  12. Screening tests • Confusion Assessment Method • 4 “A”s Test • Nursing Delirium Screening Scale • Delirium Observational Screening Scale • Recognising Acute Delirium As Routine

  13. Causes Precipitants • Infections • Drugs (on/off) • Specific organ failures • Pain • Bladder • Bowels Predisposing • Dementia • Frailty • Mobility

  14. Management

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