Clinical Review
Delirium in Elderly Patients

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Delirium is a mental disorder characterized by disturbances in consciousness, orientation, memory, thought, perception, and behavior, of acute onset and fluctuating course. It occurs in hyperactive, hypoactive, or mixed forms, in up to 50% of elderly hospital inpatients, many with pre-existing dementia, and appears to be independently associated with significant increases in functional disability, length of hospital stay, rates of admission to long-term care institutions, rates of death, and healthcare costs. Despite its clinical importance, delirium is often not detected or it is misdiagnosed as dementia or other psychiatric illness even though there are potential strategies (e.g., screening by nurses, risk-factor assessment) and instruments that can improve detection and diagnosis. Although there has been limited progress in understanding the etiology, pathogenesis, assessment, and specific treatment of delirium, systematic detection and treatment programs appear to be beneficial for elderly surgical patients, as are preventive programs for elderly medical and surgical patients. Even now, there is probably enough evidence to recommend implementation of these two types of programs in acute-care hospitals.

Section snippets

Acute Onset

The symptoms of delirium usually develop over hours-to-days, although onset may be abrupt.

Prodromal Phase

When the onset is more gradual, the patient may report mild, transient symptoms, such as fatigue, decreased concentration, irritability, restlessness, anxiety, or depression. There may be mild cognitive impairment, perceptual disturbances, or hypersensitivity to light and sound. Commonly, there is daytime somnolence or a sleep disturbance. The disturbance may be limited to this mild prodromal phase or

CONCLUSION

Delirium is a frequent and serious mental disorder in elderly patients. It is often not diagnosed, even though there are potential strategies (e.g., screening by nurses, risk-factor assessment) and instruments that can improve detection and diagnosis. Although there has been limited progress in understanding the etiology, pathogenesis, assessment, and specific treatment of delirium, systematic detection and treatment programs appear to be beneficial for elderly surgical patients, as are

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