Delirium in elderly people.
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Sharon K. Inouye, M.D., MPH,1,2 Rudi G. J. Westendorp, M.D., PhD,3,4 and Jane S. Saczynski, Ph.D.5
Delirium, an acute disorder of attention and cognition, is a common, serious, costly, under-recognized and often fatal condition for seniors. Its diagnosis requires a formal cognitive assessment and history of acute onset of symptoms. Given its typically complex multifactorial etiology, multicomponent nonpharmacologic risk factor approaches have proven to be the most effective strategy for prevention. To date, there is no convincing evidence that pharmacologic prevention or treatment is effective. Drug reduction for sedation and analgesia combined with nonpharmacologic approaches are recommended. Delirium may provide a window to elucidate brain pathophysiology, serving both as a marker of brain vulnerability with decreased reserve and a potential mechanism for permanent cognitive damage. As a potent patient safety indicator, delirium provides a target for system-wide process improvements. Public health priorities will include improvements in coding and reimbursement, improved research funding, and widespread education for clinicians and the public about the importance of delirium.
Resource: Lancet. 2014 Mar 8; 383(9920): 911–922.