DELIRIUM

Course overview

DELIRIUM IS A CLINICAL SYNDROME THAT USUALLY DEVELOPS IN THE ELDERLY. IT IS CHARACTERIZED BY AN ALTERATION OF ATTENTION, CONSCIOUSNESS, AND COGNITION, WITH A REDUCED ABILITY TO FOCUS, SUSTAIN OR SHIFT ATTENTION. IT DEVELOPS OVER A SHORT PERIOD AND FLUCTUATES DURING THE DAY. THE CLINICAL PRESENTATION CAN VARY, USUALLY WITH PSYCHOMOTOR BEHAVIORAL DISTURBANCES SUCH AS HYPERACTIVITY OR HYPOACTIVITY AND IMPAIRMENT IN SLEEP DURATION AND ARCHITECTURE. BY DEFINITION, DELIRIUM IS CAUSED BY AN UNDERLYING MEDICAL CONDITION AND IS NOT BETTER EXPLAINED BY ANOTHER PREEXISTING, EVOLVING, OR ESTABLISHED NEUROCOGNITIVE DISORDER. THE UNDERLYING CAUSE OF DELIRIUM CAN VARY WIDELY AND INVOLVE ANYTHING THAT STRESSES THE BASELINE HOMEOSTASIS OF A VULNERABLE PATIENT. EXAMPLES INCLUDE SUBSTANCE INTOXICATION OR WITHDRAWAL, MEDICATION SIDE EFFECTS, INFECTION, SURGERY, METABOLIC DERANGEMENTS, PAIN, OR EVEN SIMPLE CONDITIONS SUCH AS CONSTIPATION OR URINARY RETENTION. THE DIAGNOSIS IS OFTEN MISSED, ESPECIALLY THE HYPOACTIVE TYPE, DUE TO ITS SUBTLE CLINICAL MANIFESTATION. DELIRIUM IS DANGEROUS, OFTEN PREVENTABLE, AND ASSOCIATED WITH A SIGNIFICANT COST BURDEN AND INCREASED MORBIDITY AND MORTALITY. EFFORTS SHOULD FOCUS ON PREVENTION, EARLY DIAGNOSIS, AND TREATMENT OF THE UNDERLYING CAUSE. THIS ACTIVITY REVIEWS THE EVALUATION AND MANAGEMENT OF DELIRIUM AND THE ROLE OF INTERPROFESSIONAL TEAM MEMBERS IN COLLABORATING TO PROVIDE WELL-COORDINATED CARE AND IMPROVE PATIENT OUTCOMES.