DELIRIUM IN THE ELDERLY - 11/09/11
Résumé |
Delirium is a syndrome of disturbed consciousness, attention, and cognition or perception, which develops acutely, fluctuates during the course of the day, and is attributable to a physical disorder. 6 This syndrome is the focus of increasing attention because of its enormous impact on human suffering as well as on patient care costs. 45, 71 In the elderly, delirium is common, particularly in hospitalized patients. 30 It has a high rate of associated morbidity and mortality, 20, 37, 59 and significantly extends the length of hospital stay. 71 Its presence predicts posthospitalization cognitive decline and loss of independent community living. 20, 37, 40 It has been estimated that delirium is responsible for excess annual health care expenditures of $1 to $2 billion. 30 For all these reasons, delirium is emerging as a central focus for health care cost containment.
Delirium is a medically serious condition. In elderly patients, the presence of delirium may be the only clue to an underlying life-threatening disorder such as myocardial infarction or pneumonia. 46 Delirious patients are unable to monitor even basic self-care activities such as fluid intake and output, and thus are at risk of developing secondary conditions such as dehydration. In addition, in the midst of confusion and psychotic thinking, delirious patients may do dangerous things such as performing self-extubation, pulling out central and peripheral lines, wandering out into traffic, standing for hours in the snow in bare feet, falling down stairs, and jumping down laundry chutes.
Delirium is a treatable condition, even in the elderly patient with dementia. Early recognition of the syndrome, aggressive treatment of the underlying cause(s), and appropriate management of attendant behavioral problems all result in decreased morbidity and mortality, shorter lengths of hospitalization, and reduced costs of care. Each of these topics is addressed in the discussion to follow.
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| Address reprint requests to Sandra A. Jacobson, MD Department of Psychiatry Tufts New England Medical Center, 750 Washington Street Box 1007 Boston, MA 02111 |
Vol 20 - N° 1
P. 91-110 - mars 1997 Retour au numéro
Article précédent
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- Eugene H. Rubin
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- Dan G. Blazer
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