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Delirium May Be Under-Recognized Side Effect of Hospitalization

Patient delirium as a side effect of hospitalization has been in the news recently. It’s estimated to affect 7 million hospitalized patients each year, and while it can occur at any age, it generally affects the older population. Delirium costs the nation $143 billion annually, primarily due to longer hospital stays and follow-up nursing home care.

Delirium occurs suddenly and may fluctuate during the day. It differs from dementia that develops slowly and is progressive. Symptoms can range from agitation and combativeness to lethargy and inattention, and they may be under-diagnosed as delirium. The American Delirium Society estimates as many as 60% of delirium patients are undiagnosed.

Intensive care patients that are heavily sedated and on ventilators may be especially prone to delirium [also called ICU psychosis at one time], as many as 85% of them according to some studies. There are other diverse and multi-faceted delirium triggers as well, including large doses of anti-anxiety drugs and narcotics and the busy and noisy hospital environment itself.

As many as 40% of delirium cases may be preventable, according to some researchers. Delirium may lead to greater risk of falls, increased probability of developing dementia, and an accelerated death rate.

What are hospitals doing to prevent delirium?

  • Using medications more carefully, especially tranquilizers
  • Weaning ICU patients off ventilators sooner
  • Limiting use of restraints
  • Getting patients out of bed sooner
  • Softening the environment by shutting off room lights and minimizing noise.
  • Preserving sleep cycles
  • Ensuring patients have their eyeglasses and hearing aids to prevent disorientation
  • Keeping patients engaged with daily visitor programs
  • Using cognitive and other therapeutic activities

The Hospital Elder Life Program [HELP] has been implemented in 200 hospitals to prevent delirium development, with significant success.

Source: Boodman SG. For many patients, delirium is a surprising side effect of being the the hospital. Kaiser Health News, June 2, 2015. http://khn.org/news/for-many-patients-delirium-is-a-surprising-side-effect-of-being-in-the-hospital/


American Delirium Society: http://www.americandeliriumsociety.org/

Hospital Elder Life Program: http://www.hospitalelderlifeprogram and its delirium bibliography at http://www.hospitalelderlifeprogram.org/for-clinicians/bibliography/

Leslie DL and Inouye SK. The importance of delirium: economic and societal costs. Journal of the American Geriatrics Association 59(Supplement):S241-S243, Nov. 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415302/

MacLullich AM and others. New horizons in the pathogenesis, assessment and management of delirium. Age and Ageing 42(6):667-674, Nov. 2013. http://ageing.oxfordjournals.org/content/42/6/667.long

Popeo DM. Delirium in older adults. Mt Sinai Journal of Medicine 78(4):571–582, July 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136888/

Fong TG and others. Delirium in elderly adults: diagnosis, prevention and treatment. Nature Reviews Neurology 5(4):210–220, April 2009. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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