Abstract
Delirium is a common and serious problem for hospitalized older patients and is associated with substantial morbidity and mortality. Prevention is the most effective strategy for minimizing the occurrence of delirium and its adverse outcomes. Nurses play a crucial role in the recognition of delirium. Because nurses have multiple contacts with patients and spend more time at the bedside than physicians, therefore, they are in a unique position to observe changes in mental status fluctuations in attention, level of consciousness, and cognitive functioning at an early stage. Although nurses play a key role in recognition of delirium, it is often unrecognized by nurses. Recognition of delirium can be enhanced with education of nurses in delirium features, cognitive assessment, and factors associated with poor recognition. With awareness of predisposing and precipitation factors, prevention strategies can be developed. Education and training are needed for detection of delirium and its key features by nurses during routine clinical care.
References
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF et al (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41(1):263–306. https://doi.org/10.1097/CCM.0b013e3182783b72
Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 27(5):859–864. https://doi.org/10.1007/s001340100909
Chan D, Brennan NJ (1999) Delirium: making the diagnosis, improving the prognosis. Geriatrics 54(3):39–42. http://cat.inist.fr/?aModele=afficheN&cpsidt=9972467
Cole MG (1999) Delirium: effectiveness of systematic interventions. Dement Geriatr Cogn Disord 10(5):406–411. https://doi.org/10.1159/000017179
Csokasy J (1999) Assessment of acute confusion: use of the NEECHAM Confusion Scale. Appl Nurs Res 12(1):51–55
Ely EW, Inouye SK, Bernand GR, Gordon S, Francis J, May L et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). J Am Med Assoc 286(21):2703–2710. http://cat.inist.fr/?aModele=afficheN&cpsidt=13531387
Eden BM, Foreman MD (1996) Problems associated with underrecognition of delirium in critical care: A case study. Heart & Lung: The Journal of Acute and Critical Care 25(5):388–400. https://doi.org/10.1016/S0147-9563(96)80082-3
Flaherty JH, Rudolph J, Shay K, Kamholz B, Boockvar KS, Shaughnessy M et al (2007) Delirium is a serious and under-recognized problem: why assessment of mental status should be the sixth vital sign. J Am Med Dir Assoc 8(5):273–275. https://doi.org/10.1016/j.jamda.2007.03.006
Fong TG, Jones RN, Marcantonio ER, Tommet D, Gross AL, Habtemariam D et al (2012) Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med 156(12):848–856
Gaudreau J-D, Gagnon P, Harel F, Tremblay A, Roy M-A (2005) Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manag 29(4):368–375. https://doi.org/10.1016/j.jpainsymman.2004.07.009
Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340(9):669–676. https://doi.org/10.1056/NEJM199903043400901
Kakuma R, Galbaud du Fort G, Arsenault L, Perrault A, Platt RW, Monette J et al (2003) Delirium in older emergency department patients discharged home: effect on survival. J Am Geriatr Soc 51(4):443–450. https://doi.org/10.1046/j.1532-5415.2003.51151.x
Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK (2008) One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 168(1):27–32. https://doi.org/10.1001/archinternmed.2007.4
Luetz A, Heymann A, Radtke FM, Chenitir C, Neuhaus U, Nachtigall I et al (2010) Different assessment tools for intensive care unit delirium: which score to use? Crit Care Med 38(2):409–418. https://doi.org/10.1097/CCM.0b013e3181e0af7c
Lundström M, Edlund A, Karlsson S, Brännström B, Bucht G, Gustafson Y (2005) A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 53(4):622–628. https://doi.org/10.1111/j.1532-5415.2005.53210.x
Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN (2003) Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc 51(1):4–9
McCusker J, Cole M, Abrahamowicz M, Han L, Podoba JE, Ramman-Haddad L (2001) Environmental risk factors for delirium in hospitalized older people. J Am Geriatr Soc 49(10):1327–1334. http://doi.org/49260 [pii]
McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK (2003) Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 51(5):591–598. https://doi.org/10.1034/j.1600-0579.2003.00201.x
Michaud L, Büla C, Berney A, Camus V, Voellinger R, Stiefel F, Burnand B (2007) Delirium: guidelines for general hospitals. J Psychosom Res 62(3):371–383. https://doi.org/10.1016/j.jpsychores.2006.10.004
Milisen K, Lemiengre J, Braes T, Foreman MD (2005) Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review. J Adv Nurs 52(1):79–90
Mistraletti G, Pelosi P, Mantovani ES, Berardino M, Gregoretti C (2012) Delirium: clinical approach and prevention. Best Pract Res Clin Anaesthesiol 26(3):311–326. https://doi.org/10.1016/j.bpa.2012.07.001
Neelon VJ, Champagne MT, Carlson JR, Funk SG (1996) The NEECHAM Confusion Scale: construction, validation, and clinical testing. Appl Nurs Res 45(6):324–330. http://cat.inist.fr/?aModele=afficheN&cpsidt=10619303
O’Mahony R, Murthy L, Akunne A, Young J (2011) Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Ann Intern Med 154:746–751
Otter H, Martin J, Basell K, von Heymann C, Hein OV, Böllert P et al (2005) Specialized neurocritical care, severity grade, and outcome of patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care 5(2):150–158. https://doi.org/10.1385/Neurocrit
Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33(1):66–73. https://doi.org/10.1007/s00134-006-0399-8
Packard RC (2001) Delirium. Neurologist 7(6):327–340
Potter J, George J (2006) The prevention, diagnosis and management of delirium in older people: concise guidelines. Clin Med (Lond) 6(3):303–308
Rigney TS (2006) Delirium in the hospitalized elder and recommendations for practice. Geriatr Nurs 27(3):151–157. https://doi.org/10.1016/j.gerinurse.2006.03.014
Robinson S, Vollmer C, Jirka H, Rich C, Midiri C, Bisby D (2008) Aging and delirium: too much or too little pain medication? Pain Manag Nurs 9(2):66–72. https://doi.org/10.1016/j.pmn.2007.12.002
Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, Nava VS et al (2010) Delirium epidemiology in critical care (DECCA): an international study. Crit Care 14(6):1–7. https://doi.org/10.1186/cc9333
Schreier AM (2010) Nursing care, delirium, and pain management for the hospitalized older adult. Pain Manag Nurs 11(3):177–185. https://doi.org/10.1016/j.pmn.2009.07.002
Sloss EM, Solomon DH, Shekelle PG, Young RT, Saliba D, MacLean CH et al (2000) Selecting target conditions for quality of care improvement in vulnerable older adults. J Am Geriatr Soc 48(4):363–369
Steis MR, Fick DM (2007) Are nurses recognizing delirium? A systematic delirium? J Gerontol Nurs 34(9):40–48
Van den Boogaard M, Pickkers P, van der Hoeven H, Roodbol G, van Achterberg T, Schoonhoven L (2009) Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care 13(4):1–7. https://doi.org/10.1186/cc7991
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Küçükgüçlü, Ö. (2018). Approach to the Elderly Patient with Delirium: Nursing Perspective. In: Isik, A., Grossberg, G. (eds) Delirium in Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-65239-9_9
Download citation
DOI: https://doi.org/10.1007/978-3-319-65239-9_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-65237-5
Online ISBN: 978-3-319-65239-9
eBook Packages: MedicineMedicine (R0)