Approach to the Elderly Patient with Delirium: Nursing Perspective

  • Özlem Küçükgüçlü


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.


Elderly patient Delirium Nursing care 


  1. 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. CrossRefPubMedGoogle Scholar
  2. 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. CrossRefPubMedGoogle Scholar
  3. Chan D, Brennan NJ (1999) Delirium: making the diagnosis, improving the prognosis. Geriatrics 54(3):39–42. Google Scholar
  4. Cole MG (1999) Delirium: effectiveness of systematic interventions. Dement Geriatr Cogn Disord 10(5):406–411. CrossRefPubMedGoogle Scholar
  5. Csokasy J (1999) Assessment of acute confusion: use of the NEECHAM Confusion Scale. Appl Nurs Res 12(1):51–55CrossRefPubMedGoogle Scholar
  6. 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. CrossRefGoogle Scholar
  7. 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.
  8. 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. CrossRefPubMedGoogle Scholar
  9. 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):848–856CrossRefPubMedPubMedCentralGoogle Scholar
  10. 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. CrossRefGoogle Scholar
  11. 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. CrossRefPubMedGoogle Scholar
  12. 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. CrossRefPubMedGoogle Scholar
  13. 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.
  14. 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. CrossRefPubMedGoogle Scholar
  15. 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. CrossRefPubMedGoogle Scholar
  16. 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):4–9CrossRefPubMedGoogle Scholar
  17. 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. [pii]CrossRefPubMedGoogle Scholar
  18. 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. CrossRefPubMedGoogle Scholar
  19. 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. CrossRefPubMedGoogle Scholar
  20. 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):79–90CrossRefPubMedGoogle Scholar
  21. 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. CrossRefPubMedGoogle Scholar
  22. 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. CrossRefGoogle Scholar
  23. 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 154:746–751CrossRefPubMedGoogle Scholar
  24. 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. CrossRefGoogle Scholar
  25. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33(1):66–73. CrossRefPubMedGoogle Scholar
  26. Packard RC (2001) Delirium. Neurologist 7(6):327–340CrossRefPubMedGoogle Scholar
  27. Potter J, George J (2006) The prevention, diagnosis and management of delirium in older people: concise guidelines. Clin Med (Lond) 6(3):303–308CrossRefGoogle Scholar
  28. Rigney TS (2006) Delirium in the hospitalized elder and recommendations for practice. Geriatr Nurs 27(3):151–157. CrossRefPubMedGoogle Scholar
  29. 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. CrossRefPubMedGoogle Scholar
  30. 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. CrossRefGoogle Scholar
  31. Schreier AM (2010) Nursing care, delirium, and pain management for the hospitalized older adult. Pain Manag Nurs 11(3):177–185. CrossRefPubMedGoogle Scholar
  32. 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):363–369CrossRefPubMedGoogle Scholar
  33. Steis MR, Fick DM (2007) Are nurses recognizing delirium? A systematic delirium? J Gerontol Nurs 34(9):40–48CrossRefGoogle Scholar
  34. 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. Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine NursingDokuz Eylul University Faculty of NursingİzmirTurkey

Personalised recommendations