Delirium Follow-up

  • Author: Kannayiram Alagiakrishnan, MD, MBBS, MHA, MPH; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: May 8, 2012
 

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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Further Outpatient Care

  • Following recovery, patient's memories of events of the delirium are variable.
  • 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.
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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

  • 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.[28]
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Prognosis

  • 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

  • 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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Contributor Information and Disclosures
Author

Kannayiram Alagiakrishnan, MD, MBBS, MHA, MPH  Associate Professor, Department of Medicine, Division of Geriatric Medicine, University of Alberta Faculty of Medicine and Dentistry, Canada

Kannayiram Alagiakrishnan, MD, MBBS, MHA, MPH is a member of the following medical societies: American College of Physicians and American Geriatrics Society

Disclosure: Nothing to disclose.

Coauthor(s)

Patricia Blanchette, MD  Department Chair and Director, Geriatric Medicine Fellowship Program, Professor of Geriatric Medicine, Geriatric Medicine, John A Burns School of Medicine, University of Hawaii

Patricia Blanchette, MD is a member of the following medical societies: American College of Physicians, American Geriatrics Society, American Medical Association, American Medical Directors Association, Gerontological Society of America, and Hawaii Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Otsuke Grant/research funds reseach; Merck Honoraria Speaking and teaching

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of Health Sciences: Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

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Table 1
FeaturesDeliriumDementia
OnsetAcuteInsidious
CourseFluctuatingProgressive
DurationDays to weeksMonths to years
ConsciousnessAlteredClear
AttentionImpairedNormal, except in severe dementia
Psychomotor changesIncreased or decreasedOften normal
ReversibilityUsuallyRarely
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