neurologic disorders
Delirium
Geriatrics Essentials for Delirium
Delirium is more common among older people. About 15 to 50% of older patients experience delirium at some time during a hospital stay. For older patients in an ICU, risk of delirium (ICU psychosis) is particularly high. Stress of any kind impairs cholinergic function, thus contributing to delirium. Older people are particularly vulnerable to reduced cholinergic transmission, increasing their risk of delirium. Anticholinergic medications can contribute. Delirium is often the first sign of another, sometimes serious disorder in older people. Causes of delirium in older peopleoften include less severe conditions: Dehydration A nonneurologic disorder (eg, Introduction to Urinary Tract Infections (UTIs) , Pain Urinary retention or severe constipation Sensory deprivation Sleep deprivation Stress (any type) Use of a bladder catheter Certain age-related changes make older people more susceptible to developing delirium: An increased sensitivity to drugs (particularly sedatives, anticholinergics, and antihistamines) Changes in the brain (eg, atrophy, lower levels of acetylcholine) The presence of conditions that increase the risk of delirium (eg, stroke, dementia, Parkinson disease, other neurodegenerative disorders, polypharmacy, dehydrations, undernutrition, immobility) The most obvious symptom of delirium,confusion, may be harder to recognize in older people. Younger people with delirium may be agitated, but very old people tend to become quiet and withdrawn—changes that may be mistaken for depression. In such cases, recognizing delirium is even harder. If a psychosis develops in an older person, it usually indicates delirium or dementia. Psychosis due to a psychiatric disorder rarely begins during old age. Delirium can be a common presenting symptom in older patients with viral diseases. For example, COVID-19 may manifest as delirium without other typical symptoms or signs of COVID-19. Delirium is also associated with poor hospital outcomes (eg, need for ICU care) and death in patients with COVID-19 ( Geriatrics essentials reference ). Memory impairment and inattention may also be the initial symptoms of delirium in older people. In older people, delirium tends to last longer, and recovery may be slow (days to even weeks or months), resulting in longer hospital stays, increased risk and severity of complications, increased costs, and long-term disability. Some patients never fully recover from delirium. Because older patients are more likely to have dementia, delirium is often overlooked by clinicians. Clinicians should consider delirium in any older patient who presents with impairment in memory or attention. Consider delirium in any older patient who presents with impairment in memory or attention. managed by an Geriatric Interdisciplinary Teams can benefit older patients because delirium and the hospitalization it usually requires can result in 1.Kennedy M, Helfand BKI, Gou RY, et al: Delirium in older patients with COVID-19 presenting to the emergency department.JAMA Netw Open3 (11):e2029540, 2020. doi:10.1001/jamanetworkopen.2020.29540 