THE IMPAIRED MENTAL FUNCTIONING OF THE ELDERLY: DELIRIUM ( ( (Non…
THE IMPAIRED MENTAL FUNCTIONING OF THE ELDERLY:
: Delirium, also known as acute confusional state, is an organically caused decline from a previously baseline level of mental function. It often varies in severity over a short period of time, and includes attentional deficits, and disorganization of behavior.
Potentially modifiable risk factors
• Sensory impairment (hearing or vision)
• Immobilization (catheters or restraints)
• Medications (for example, sedative hypnotics, narcotics, anticholinergic drugs, corticosteroids, polypharmacy, withdrawal of alcohol or other drugs)
• Acute neurological diseases (for example, acute stroke [usually right parietal], intracranial haemorrhage, meningitis, encephalitis)
• Intercurrent illness (for example, infections, iatrogenic complications, severe acute illness, anaemia, dehydration, poor nutritional status, fracture or trauma, HIV infection)
• Metabolic derangement
Non modifiable risk factors
• Dementia or cognitive impairment
• Advancing age (>65 years)
• History of delirium, stroke, neurological disease, falls or gait disorder
• Multiple comorbidities
• Male sex
• Chronic renal or hepatic disease
It may result from an underlying disease, over-consumption of alcohol, drugs administered during treatment of a disease, withdrawal from drugs . Delirium may be caused by a disease process outside the brain that nonetheless affects the brain, such as infection ( pneumonia) or drug effects, particularly anticholinergics.
The pathophysiology of delirium is not fully understood, and the condition might arise through a variety of different pathogenic mechanisms. Current evidence suggests that drug toxicity, inflammation and acute stress responses can all contribute markedly to disruption of neurotransmission, and, ultimately, to the development of delirium
The clinical presentation of delirium is hypoactive, hyperactive and mixed on the basis of psychomotor behavior. Patients with hyperactive delirium demonstrate features of restlessness, agitation and hyper vigilance and often experience hallucinations and delusions. patients with hypoactive delirium present with lethargy and sedation, respond slowly.
Non pharmacological acute treatment strategies
include reorientation and behavioural intervention. Caregivers should use clear instructions and make frequent eye contact with patients. Physical restraints should be avoided because they lead to decreased mobility, increased agitation, greater risk of injury, and prolongation of delirium. providing a quiet patient-care setting, with low-level lighting at night.minimal noise allows an uninterrupted period of sleep at night
. Haloperidol, Risperidone, Olanzapine, Lorazepam are commonly used in patients who might compromise safety especialy those with hyperactive delirium