delirium

introduction

delirium is common in elderly hospital inpatients and is associated with increased morbidity and mortality
early recognition, investigation and management with appropriate inpatient team care is essential to good outcomes by minimising functional and cognitive decline, pressure ulcers and preventing falls.
it should be differentiated from a primary psychiatric diagnosis such as a psychosis, or from drug or alcohol related withdrawal states.
it has been proposed that glymphatic dysfunction is the central cause of delirium¹⁾
post-operative delirium may increase risk of dementia
- thought go be due to stresses altering two “epigenetic” mechanisms that impair of BDNF–ARC signaling that control whether genes are turned on or off. The resulting changes impaired the brain's ability to form memories and learn new information while also disrupting the internal clock that regulates healthy sleep patterns. This appears to be prevented by vorinostat.²⁾

the diagnosis of delirium generally requires a present and abnormal rating for criteria (1) AND (2) AND EITHER (3 or 4) of the CAM confusion assessment test for diagnosis of delirium
Mental state - delirium vs dementia vs psychosis

pillow under legs to keep heels from contact
avoid routine IDC insertion
bladder scan after each void + minimum once per nursing shift to detect acute urinary retention and Mx accordingly (eg. consider in/out catheter but if needed more than twice then insert IDC)
early referral to Aged Care inpatient team if aged > 65 years or with known dementia and not likely to be a primary psychiatric diagnosis (otherwise refer to Aged Persons Mental Health Unit)

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