Delirium Follow-up

Updated: Sep 22, 2016
  • Author: Kannayiram Alagiakrishnan, MD, MBBS, MHA, MPH; Chief Editor: Randon S Welton, MD  more...
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Follow-up

Further Outpatient Care

Following recovery, patient's memories of events of the delirium are variable. Be sure to educate the patient, family, and primary caregivers about future risk factors.

It is not unusual for patients who are elderly to require 6-8 weeks or longer for full recovery. In particular, elderly patients with postacute care complications are at risk for prolonged and persistent delirium. [43]

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Further Inpatient Care

Carefully assess patients to determine their level of care needs. Assessment should include behavior (24 h), daily mental status, potential for injury, and underlying medical and metabolic status.

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Deterrence/Prevention

Prevention should be the goal because delirium is associated with adverse outcomes and high health care costs.

A multicomponent intervention study that targeted cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration showed significant reduction in the number and duration of episodes of delirium in older patients who were hospitalized.

Patients who are at high risk for delirium should be monitored closely as outpatients, during hospitalization, and throughout surgical procedures.

Physicians should become familiar with prescribing practices for patients who are elderly, keeping dosages low and avoiding medications that cause delirium.

Monitoring the patient's mental status as a vital sign helps to diagnose delirium early.

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Complications

Complications of delirium may include the following:

  • Malnutrition, fluid and electrolyte abnormalities
  • Aspiration pneumonia
  • Pressure ulcers
  • Weakness, decreased mobility, and decreased function
  • Falls and combative behavior leading to injuries and fractures
  • Wandering and getting lost
  • Long-term cognitive impairment: Accumulating evidence shows that delirium is not only a transient, reversible acute confusion, but also can give rise to a persistent long-term cognitive impairment. [44]
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Prognosis

Delirium significantly worsens prognosis and is associated with increased mortality at discharge and at 12 months. A significant proportion of patients with delirium during their hospital admission continued to demonstrate symptoms of delirium at discharge, 6-month, and 12-month follow-up. [19]

Resolution of symptoms may take longer in patients with poor premorbid cognitive function, incorrect or incomplete diagnosis of contributing factors, and structural brain diseases treated with large doses of psychoactive medications prior to the onset of acute medical illness.

For some patients, the cognitive effects of delirium may resolve slowly or not at all.

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Patient Education

Patient and family education

See the list below:

  • Educating families and patients regarding the etiology and course of disease is an important role for physicians.
  • Educate the patient, family, and primary caregivers about future risk factors.
  • Families may worry that the patient has brain damage or a permanent psychiatric illness. Providing reassurance that delirium often is temporary and is the result of a medical condition may be beneficial to both patients and their families.
  • Suggest that family members or friends visit the patient, usually one at a time, and provide a calm and structured environment. Encourage them to furnish some familiar objects, such as photos or a favorite blanket, to help reorient the patient and make the patient feel more secure.
  • Patient and family education materials are available here:
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