Not a Peep: Delirium in the Geriatric Patient
Delirium is a common acute geriatric syndrome with a fluctuating course that is characterized by inattention and cognitive changes that may not be attributed to dementia. Older patients, those with comorbidities or history of psychiatric illness as well as those with cognitive disorders or geriatric syndromes are at increased risk of developing delirium. Delirium is multifactorial and is often the first indicator of an acute illness in the geriatric patient. The work-up for delirium should include review of the patient’s medications, evaluation for environmental factors as well as laboratory and radiologic studies. The mainstay for treating delirium is to identify and treat the underlying cause. Many treatment measures are also good preventive measures and include establishing normalcy for the patient by providing a care environment that is as similar to their home environment as possible and maintaining their daily schedule and regimen. Physical restraints should not be used and pharmacologic treatment should only be considered when there is concern about the patient’s safety or the safety of others, non-pharmacologic treatments have already been utilized, and the underlying cause has been treated. Delirium has many long-term effects including distress, cognitive decline, loss of function, and increased morbidity and mortality. Patients with delirium also have longer hospital stays and there is increased economic cost.