Clinical Practice Guidelines for Management of Delirium in Elderly

Autor: Sandeep Grover, Ajit Avasthi
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: Indian Journal of Psychiatry
ISSN: 1998-3794
0019-5545
Popis: Delirium is an acute, transient, usually reversible neuropsychiatric syndrome, seen in medical-surgical set-ups. It is considered to be a serious problem in acute care settings. Although delirium is encountered in all age groups, elderly are considered to be a high-risk group for development of delirium. It basically reflects decompensation of cerebral functions, as a result of one or more pathophysiological processes. Unfortunately, on many instances delirium is not detected or the detection is delayed. Delirium is known to be associated with varied negative outcomes like prolonged hospital stay, need for institutional care, poor functionality and high treatment costs. It has also been shown to be associated with high short-term and long-term mortality. Besides these, delirium has been shown to be associated with significant distress to the patient and the family. Due to all these negative consequences, it is very important to prevent the development of delirium in medically ill patients. It is also important to detect this entity at the earliest and manage the same to reduce the associated morbidity, mortality and distress among patients and their caregivers. Earlier it was thought that delirium is not associated with any long-term consequences, but now it is increasingly being recognised that in the long run, delirium is associated with cognitive decline and development of dementia. Indian Psychiatric Society had published clinical practice guidelines (CPGs) for management of various psychiatric disorders amongst elderly for the first time in the year 2007. In the earlier version, management of delirium was included under the CPGs for management of Psychosis amongst elderly. This time it is felt that management of delirium involves a broader range of evaluations and interventions and hence, an effort is made to have separate CPGs for management of delirium. The new guidelines are an attempt to provide updated information on the subject and use the newer information in formulating the guidelines. Although these guidelines are published as part of CPGs for Geriatric Psychiatry, these guidelines can also be applied to patients of other age groups with delirium. For these guidelines, Internet searches were carried out by using search engines of PUBMED, Embase and Google Scholar to find out the available evidence based literature both for non-pharmacological and pharmacological management. Available treatment guidelines on the topic by different organizations were also reviewed for formulation of the guidelines. Epidemiology of delirium Epidemiology of delirium has been evaluated across different treatment settings across the world and the incidence and prevalence is influenced by the treatment setting (Intensive care units, medical/surgical ward, post-operative patients, consultation-liaison psychiatry services), population assessed (elderly, pediatrics, adult, mixed age group) and method used for estimation (screening instrument, diagnostic instrument) of delirium. In general, data suggest an incidence rate of 3 to 42% in hospitalized patients and prevalence to vary from 5 to 44% amongst the hospitalized patients. Data also suggests that the incidence and prevalence of delirium is much higher among patients admitted to various intensive care units (ICUs) with prevalence reported to be as high as 82% with higher rates amongst those requiring mechanical ventilation. Studies evaluating patients in the emergency department, suggest that about 40% of patients have delirium. Studies from India, which have evaluated the incidence of delirium in various intensive care units, have reported prevalence rates to vary from 26.2% to 68.2% and the incidence rates to vary from 9.27 % to 59.6%. Studies, which have evaluated the course of delirium in ICU settings, suggest that the delirium usually starts after 2 (SD-1.7) days of admission to the ICU and lasts for 4.2 (SD-1.7) days.
Databáze: OpenAIRE
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