Materiały źródłowe

• #1 Delirium (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568723/

  Delirium, also known as an acute confessional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of attention, consciousness, and cognition, with a reduced ability to focus, sustain or shift attention. It develops over a short period of time and fluctuates during the day. The clinical presentation can vary, usually demonstrating psychomotor behavioral disturbances such as hyperactivity or hypoactivity and with impairment in sleep duration and architecture. […] Delirium is dangerous, often preventable, and associated with a significant cost burden and increased morbidity and mortality. Efforts should focus on prevention, early detection, and treatment of the underlying cause. This activity reviews the evaluation and management of delirium and the role of interprofessional team members in collaborating to provide well-coordinated care and improve patient outcomes.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Delirium-Symptoms.aspx

  Delirium is a sudden state of severe mental confusion that can occur as a result of illness, surgery or the use of some medications. […] Delirium is present in about 15 to 20% of patients who are admitted to hospital. […] Although these facts are known, delirium is still underdiagnosed and inadequately managed, with as many as two thirds of cases being overlooked in some healthcare settings. […] For critically ill patients, clinicians can use the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to detect delirium and this tool is particularly useful for patients on mechanical ventilation. […] Another diagnostic tool that may be used in the ICU setting is the Intensive Care Delirium Screening Checklist (ICDSC).

• #1 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Older people who experience delirium are at greater risk of functional and cognitive decline, falls, hospital acquired infections, pressure injuries and incontinence. […] Delirium is preventable in 30-40 per cent of cases. […] After an episode of delirium in hospital, an older persons cognitive function and ability to manage at home or in care may be impacted. […] Discharge planning should be documented, include the patient, carers and other professionals, and incorporate referrals to community health and support services where required. […] Encourage independence in activities of daily living and minimise risk of falls. […] Reducing, ceasing or avoiding the use of psychoactive drugs is recommended as they may worsen the delirium. […] Pharmacological therapy should only be considered in severe cases of behavioural or emotional disturbance because there is no strong evidence they effectively improve prognosis.

• #1 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium is an acute disturbance in a persons attention, awareness and cognition that can be caused by an acute medical condition or medication changes. Delirium is serious and may be the only sign of a deteriorating patient. […] Delirium should be treated as a medical emergency. […] Delirium can often be prevented and can be treated and managed. As clinicians we must listen to the families of our patients when they tell us the person seems confused. […] We must recognise and respond to delirium as we would any other medical emergency. […] Delirium develops quickly and symptoms fluctuate throughout the day. […] Delirium can be hyperactive, hypoactive (quiet delirium) or mixed. […] Delirium develops quickly, over hours or days, and symptoms fluctuate throughout the day and are often worse at night.

• #1 Acute Confusional States in the Elderly—Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3371633/

  In many cases, delirium can be diagnosed and treated in good time. Prevention is preferable to treatment. […] The immediate initiation of a time-consuming detailed workup can be dispensed with if, for example, delirium in a patient with advanced dementia is found to have been induced by a typical precipitating factor (drugs, dehydration, etc.). […] Hypoactive delirium poses a special diagnostic problem, because the patients attention deficit may seem to reflect nothing more than impaired cognitive performance. […] The treatment of delirium can be directed at the causes of delirium, its manifestations, or both; symptomatic treatment can be either with drugs or with non-pharmacological means. […] Non-pharmacological measures also play a major role in the treatment of delirium.

• #1 Delirium: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/delirium-nursing-diagnosis-care-plan/

  Delirium is an acute disturbance of mental status and cognition with an acute onset of hours or days. It is often related to dehydration, infection, medications, alcohol withdrawal, dementia, organ failure, severe pain, or the dying process. […] Nurses play a crucial role in identifying patients experiencing delirium. Because they are the ones that provide round-the-clock bedside care, nurses should be among the first to notice any changes in cognitive behavior in the inpatient setting. […] The first step to treatment is to identify the underlying cause. This will prevent further mental status deterioration and reduce safety risks. Nurses can educate family members on identifying signs of delirium. […] Delirium results in acute disorientation and disruptions in cognition. […] Nursing Diagnosis: Acute Confusion

• #1 Acute Confusion Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/acute-confusion-nursing-diagnosis-care-plan/

  Acute confusion is an abrupt disruption in consciousness, attention, cognition, and perception. It is reversible and is a symptom of an underlying condition. The nurses role in acute confusion is to first ensure patient safety. Patients experiencing hallucinations, decreased consciousness, paranoia or anxiety are a safety risk to themselves and others. Along with implementing treatment and assessing for new or worsening confusion the nurse applies therapeutic interventions to relax the patient and provide a calming environment. […] The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to acute confusion. […] Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with acute confusion. […] Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care.

• #1 Acute Confusion (Delirium) Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/acute-confusion/

  After a thorough assessment, a nursing diagnosis is formulated to address acute confusion based on the nurses clinical judgment and the patients unique condition. […] The nursing assessment for acute confusion involves gathering information on the patients cognitive function, medical history, medication use, and potential contributing factors to identify the underlying cause of confusion and develop an effective care plan. […] The nursing interventions for managing confusion and delirium aims to manage and treat the underlying cause of confusion, promote patient safety, optimize cognitive function, and educate patients and families on strategies to prevent or manage future episodes of acute confusion. […] Early intervention prevents long-term complications. Because delirious clients are often confused and unable to provide accurate information, getting a detailed history from family and caregivers is particularly important. Delirium should always be suspected when a new onset or an acute or subacute deterioration in behavior, cognition, or function occurs, especially in clients who are older adults, demented or depressed.

• #1 Abrupt change in mental status | HIGN

  https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

  Current evidence-based guidelines focus on prevention, recognition, and management of delirium in the complex older adult. Cognitive screening using the Confusion Assessment Method (CAM) and other instruments are recommended for all older patients admitted to the hospital. Many cases of delirium develop during a patients stay upon exposure to risk factors such as infection, drug intoxication, and unfamiliar environment. For patients identified at high risk for delirium, health care providers and nurses are encouraged to incorporate non-pharmacological prevention strategies into the plan of care. Nurses can regularly reorient the patient to his or her environment and ensure adequate sensory stimulation to prevent confusion. Medications should be reviewed every 24 hours by nurses, providers, and pharmacists to ensure they are appropriate for patients condition. A geriatric psychiatry consult may be ordered to assess appropriateness of prescriptions and adjust medications to keep use of sedatives and tranquilizers to a minimum.

• #1 Nursing Home Toolkit | Delirium/Acute Confusion

  https://www.nursinghometoolkit.com/delirium.html

  Core features of delirium include acute and fluctuating course, inattention, disorganized thinking and change in level of consciousness (hyper-alert, drowsy, or coma). […] Delirium is a medical emergency that should be communicated to the members of the healthcare team immediately. […] Good nursing care is at the core of delirium prevention. Keep residents mobile, hydrated and engaged in activities they enjoy. […] Don’t discharge patients with delirium from post-acute care without an appropriate delirium treatment, care management, and communication plan for transitioning care and ensuring ongoing follow-up.

• #1 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is a fast-developing type of confusion that affects your ability to focus your attention and awareness. […] Delirium is more common in medical settings, such as during long hospital stays or in long-term care facilities. […] Delirium can often get better during the day and worse as nighttime approaches, which is why this condition sometimes gets the incorrect name of sundowning. […] Delirium is often preventable, but most preventive measures are things only clinical personnel should do. […] However, family, friends and loved ones can play a very important role in reducing the risk of delirium. […] Healthcare providers will treat causes and contributing factors they can identify. Helping people with mobility and activity or removing tethers can help delirium get better. […] Monitoring and adjusting medications can also help improve delirium while you undergo treatment for the underlying causes.

• #1 8 Important Nursing Assessments for the Patient with Confusion | Medbridge

  https://www.medbridge.com/blog/eight-important-nursing-assessments-for-the-patient-with-confusion

  Remember that a patient with well-known, long-term confusion can have delirium (acute onset confusion) as well as dementia at the same time. Do not dismiss the patient with a diagnosis of dementia, Alzheimer’s, or brain injury as simply being „confused as always.” Today, their confusion may be different than the day or week prior, and it may be more dangerous. The nurse’s role is to look beyond the diagnosis of dementia and prevent an acute situation from worsening. […] As nurses, we must prioritize providing a full assessment to the confused patient. We are among those who can prevent hospitalization and even save a life.

• #1 Acute Confusion (Delirium) Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/acute-confusion/

  Nurses play a vital role in caring for patients with acute confusion, ensuring that the nursing care plan is tailored to individual needs. The plan includes assessing and monitoring mental status, ensuring a safe environment, managing behavioral issues, and maintaining communication with the healthcare team and family. Use this nursing diagnosis guide to develop an effective acute confusion nursing care plan. […] A person with dementia can experience acute confusion (delirium). Careful assessment is indicated to determine the prehospital function and deliberate with the family to perceive deterioration. […] The nursing goals and outcomes for acute confusion aim to identify and treat the underlying cause of confusion, promote safety and prevent harm, optimize patient cognition and functional status, and educate patients and families about strategies to manage acute confusion.

• #1 Delirium: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/delirium-nursing-diagnosis-care-plan/

  Nursing Diagnosis: Impaired Social Interaction […] Expected outcomes: Patient will respond appropriately to questions. Patient will participate in a group setting within their capabilities. […] Ensure that medications are taken as prescribed. Some patients may not take medications correctly, either overdosing or underdosing. […] Provide a calm environment. Allow the patient to interact with familiar faces by providing an isolated, quiet, and nonstimulating environment. […] Risk for Injury […] Nursing Diagnosis: Risk for Injury […] Expected outcomes: Patients family will implement strategies to reduce the risk of injury. Patient will remain free of injury. […] Remain with the patient when agitated or combative. Staff may need to remain at a distance to prevent injury to themselves, but remaining at the bedside may be necessary to prevent the patient from injuring themselves. Restraints are considered as a last resort.

• #1 Delirium: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/delirium-nursing-diagnosis-care-plan/

  Expected outcomes: Patient will demonstrate appropriate orientation to person and place. Patient will cooperate with care and assessments. Patient will communicate needs and follow commands. […] Assess electrolytes and other laboratory test results. Abnormalities such as metabolic alkalosis, hyponatremia, hypoglycemia, or any signs of infection can signal an underlying cause of delirium. […] Reorient the patient as needed. Help to maintain reality and prevent anxiety by orienting to place and time as needed. […] Treat the underlying cause. An infection may require antibiotics. Severe pain can be treated with opioids. Alcohol withdrawal is treated with anti-anxiety medications. Dehydration requires fluid resuscitation and supplemental electrolytes. […] Impaired social interaction can happen in patients experiencing delirium due to altered thinking and inappropriate behavior.

• #1 Delirium (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568723/

  The main treatments for delirium are based on non-pharmacologic interventions as there are no FDA-approved medications for the treatment or prevention of delirium. Preventing delirium from occurring is the most efficacious intervention. Identifying patients at risk for delirium and taking special precautions to prevent delirium is crucial. Non-modifiable risk factors include a history of an underlying neurodegenerative disorder such as dementia and increasing age. Modifiable factors include medications, infections, environmental factors, and reduced sensory input. […] The primary treatment for delirium is based on prevention and non-pharmacologic interventions because there are no FDA-approved medications for the treatment or prevention of delirium.

• #1 Delirium – symptoms, diagnosis and treatment | Alzheimer’s Society

  https://www.alzheimers.org.uk/get-support/daily-living/delirium

  A supportive and calm environment can also help someone recover from delirium. Healthcare professionals, family and friends can all help a person by: talking calmly in short clear sentences, reminding them where they are and who you are, bringing familiar objects from home, such as photographs, helping them to eat and drink regularly, making sure glasses and hearing aids are clean and working properly, and that they are wearing them, setting up a 24-hour clock and calendar that they can see clearly, helping them get into a healthy sleep routine, providing reassurance if they have distressing hallucinations or delusions, supporting them to get up and about, as soon as its safe to do so, not taking them to new environments that are unfamiliar, busy or confusing. […] For many people the symptoms of delirium usually improve in a few days, once the underlying causes have been treated. However, some people dont make a quick or full recovery and may still be having problems with memory and thinking several weeks or even months after becoming unwell.

• #1 Alzheimer’s Disease and Delirium: Guidance and Tips

  https://www.webmd.com/alzheimers/confusion-delirium

  Its normal for people with Alzheimers disease to feel more confused as time passes. But sometimes this confusion gets worse very quickly, over a matter of hours or days. If this happens with your loved one, take them to a doctor as soon as possible to be sure that its not delirium. […] Since delirium is usually caused by a health problem, its important to talk with your loved ones doctor about finding the reason for it and to follow any treatment instructions. […] You also can do a few things to help manage delirium: Talk to your loved one calmly. Make eye contact. If theyll let you, use a gentle touch. Give simple, clear instructions. Tell them often what day it is, what time it is, where they are, and who the people around them are. If theyve had Alzheimers disease for a while, reminders may not help. If your loved one seems upset by them, try to just go along with whatever they say or believe. When you do things to take care of them, remind them who you are and tell them what youre about to do. Help them remember the time, date, where they are, and what theyre doing. It helps to use something they can see, like a clock or watch, calendar, or daily schedule. Keep the area around them familiar and calm. Lower loud, distracting noises, such as phones or loud TVs, but dont have complete silence. You may want to softly play their persons favorite music or TV show. Put on soft lighting. Try a 40- to 60-watt night light. Try to keep your homes temperature between 70 and 75 F. Stay away from very high or low temperatures, inside or outside. Have family and other familiar people spend time with them, but dont have too many visitors at once. Try to stick to a structured routine. Make sure your loved one drinks enough fluids. Encourage them to get up and walk around. Provide help if needed. If they need glasses, a hearing aid, or dentures, try to make sure they wear them. Check that their glasses are clean and the right ones for the distance. Make sure their hearing aid works and is turned on.

• #1 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  A health care provider can diagnose delirium based on medical history and tests of mental status. The first goal of delirium treatment is to address any causes or triggers. Supportive care aims to prevent complications. If you’re a family member or caregiver of someone who has delirium, talk with the health care provider about medicines that may trigger the symptoms. To promote good sleep habits: Provide a calm, quiet setting. To help the person remain calm and aware of their surroundings: Provide a clock and calendar and refer to them during the day. To help prevent medical problems: Give the person the proper medicines on schedule. Caring for a person with delirium can be scary and exhausting. If you’re the relative or primary caregiver of a person with delirium, you’ll likely play a role in making an appointment or providing information to the health care provider.

• #1 Temporary Confusion & Disorientation (Delirium): Causes & Treatment

  https://www.webmd.com/brain/sudden-confusion-causes

  Once doctors can get the cause under control, the confusion usually goes away. It can take hours or days to recover, sometimes longer. In the meantime, some people may need medication to keep them calm and help with their confusion. […] As the person gets better, it may help to: Make sure they get enough to eat and drink. Encourage them to move around (with your help). Get them on a normal sleep schedule. Surround them with comforting and familiar objects (like family photos). Dont overwhelm them with too much noise or too many visitors, but dont isolate them either.

• #1 Management of acute confusion (delirium) in older people – South & West

  https://southwest.devonformularyguidance.nhs.uk/formulary/chapters/4-central-nervous-system/acute-confusion-in-older-people

  Frequent complications of delirium are: Falls, Pressure sores, Malnutrition, Continence problems, Functional impairment. […] Drug intervention is often unnecessary. Some elderly people present with a hypoactive form of delirium where the patient is quiet, withdrawn and may not need sedation. In these patients detection is also important because of the high morbidity and mortality of delirium. […] It is important to remember the following basic principles: Use of sedatives or major tranquilisers should be kept to a minimum […] All medication should be reviewed as frequently as possible. […] Sedation may be used when carrying out essential investigations or treatment, to prevent the patient endangering themselves or to relieve distress in an agitated or hallucinating patient. […] Dementia with Lewy Bodies (DLB): patients are extremely sensitive to antipsychotic medication and this may result in a sudden onset of EPSE, profound confusion, deterioration and death. DLB accounts for approx. 15% of cases of dementia among people aged over 65 (overall population incidence 0.75%). Characteristic symptoms are dementia, marked fluctuation of cognitive ability, early and persistent visual hallucinations and spontaneous motor features of Parkinsonism.

• #1 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Assessment for and prevention of delirium should occur at admission to the hospital and throughout the stay. […] Nonpharmacologic prevention strategies consist of orientation and therapeutic activities, early and recurrent mobilization, minimizing the use of psychoactive medications, promoting normal sleep-wake cycles, providing easy access to adaptive equipment for sensory impairment (e.g., glasses, hearing aids), and preventing dehydration. […] Once delirium is diagnosed in an inpatient setting, it is important to identify and treat the underlying causes. After the causative factors are addressed, focus should shift to nonpharmacologic measures, providing supportive care, and preventing complications. […] Pharmacologic therapy should be reserved for patients who are a threat to their own safety or the safety of others. By convention, haloperidol has been the agent of choice for treatment of delirium, despite a higher incidence of extrapyramidal adverse effects.

• #1 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Delirium is defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition. It is common in older persons in the hospital and long-term care facilities and may indicate a life-threatening condition. Assessment for and prevention of delirium should occur at admission and continue throughout a hospital stay. Caregivers should be educated on preventive measures, as well as signs and symptoms of delirium and conditions that would indicate the need for immediate evaluation. […] Treatment of delirium should focus on identifying and managing the causative medical conditions, providing supportive care, preventing complications, and reinforcing preventive interventions. […] Physicians should train nursing staff, home health aides, and family members/caregivers on recognizing and treating delirium.

• #1 Delirium: Prevent, Identify, Treat | ANA Enterprise

  https://www.nursingworld.org/practice-policy/work-environment/health-safety/delirium/

  Delirium is an acute, serious, and often preventable, medical condition characterized by confusion and a disturbed thought process, often following assault to the body such as surgery, infection, dehydration, or certain medications. Delirium affects large numbers of patients across all healthcare settings, including children, by negatively impacting patient outcomes, causing family caregiver distress and increasing financial costs. […] Since frontline nurses are in direct contact with patients 24 hours per day and seven days a week, RNs need to drive delirium prevention. The best prevention protocol simply consists of high-level nursing care. […] Proper clinical identification of delirium and quick use of personalized evidence-based interventions is the hallmark of treatment. Failure to identify and treat can result in increased costs but even more importantly, poor patient outcomes and subsequent decreased quality of life.

• #1 Tip Sheet: Managing Delirium in Older Adults | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/tip-sheet-managing-delirium-older-adults

  Delirium is a sudden change in mental status that can be caused by a number of factors. […] Many factors can contribute to delirium, including acute illness, surgery, and medications. […] When delirium isnt recognized, it can delay an older persons recovery. […] Prolonged delirium can have a lasting impact on an older persons health and well-being. […] Delirium can start to happen in just a few hours. […] As a friend or family member, you know the older person better than the hospital staff, so you are often the first person to see signs of delirium. […] Be sure to report your concerns right away. […] Since you know the older person best, you can quickly pick up on changes in their mental state. […] Tell the healthcare staff right away if you notice anything unusual. […] Friends and family offer comfort and familiarity.

• #1 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  People who move around early in treatment (with medical guidance) had a lower risk of developing delirium in large clinical trials. […] Loved ones can play a significant role in preventing and addressing delirium for someone in a medical setting. […] Social interactions with family, friends and other loved ones can be a major help in preventing delirium. […] If your loved one has delirium in a medical setting, they need regular medical care.

• #1 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  Delirium (sudden confusion) usually affects peoples brains for a short time. It is a common condition. Up to 1 in 3 people admitted to hospital become delirious at some time during their stay. […] Depending on how bad the delirium is, a person may need to go into hospital for treatment and management. For others, delirium can be treated at home. […] Family members and carers have an important role. They can help to manage delirium in hospital or at home. […] In hospital, you can tell the nurse or doctor looking after the person about the symptoms you have noticed. At home, you can talk to a GP. […] Some people with delirium need to come into hospital to manage the condition or what is causing it. […] Sometimes, we give the person with delirium calming or sedating medicines. We use these medicines if the person is still distressed or unsafe after we have tried other ways to keep them calm.

• #1 Caring for Someone With Delirium | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/delirium

  There are many ways you can help someone with delirium, such as: Having a regular day and night schedule for them and helping them keep a normal sleep pattern. […] It can be hard to talk to someone with delirium, but its important to be patient and understanding. […] The persons doctor, nurse, social worker, and case manager will help you plan for their care at home. Call their doctor or nurse if you have any questions or concerns.

• #1 Home – Delirium Central

  https://www.deliriumcentral.org/

  Family members, caregivers, and friends are often the first witnesses of a loved one experiencing an episode of delirium, or acute confusion. These resources for family members and caregivers of older adults will give you information about what delirium looks like and provide tips on how to help your loved one before, during, and after a hospitalization. […] The role of the caregiver or family member is essential. It is important for a patient to have support and companionship both in the hospital and when they returns home. […] There are many ways that people can stay healthy and feel their best, both at home and during a hospital stay. […] We have also provided additional resources on how to best manage your hospital stay. […] The goals of the American Delirium Society are to foster research, education, quality improvement, advocacy implementation science to minimize the impact of delirium on short- and long-term health and well-being of patients.

• #1 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  When a person leaves hospital after delirium, they may need more support than usual. They may be at higher risk of falls and need some changes in the home to make sure that their environment is safe. […] We try to make sure that people get the right level of support when they leave hospital. This includes rehabilitation to improve, restore and maintain their everyday skills and mobility.

• #1 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics/print

  The goal of supportive care is to maintain the patient’s health, prevent additional complications, and avoid those factors that can aggravate delirium. […] Delirium has an enormous impact upon the health of older people. Patients with delirium may experience prolonged hospitalizations and a decreased ability to function independently, and are at high risk for requiring care in a long-term care facility (eg, nursing home). […] Even patients that appear to have recovered from delirium may have trouble remembering medications and self-care instructions.

• #1 Delirium: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/288890-overview

  Delirium that causes injury to the patient or others should be treated with medications. The most common medications used are antipsychotic medications. Benzodiazepines often are used for withdrawal states. […] Educating families and patients regarding the etiology and course of disease is an important role for physicians. […] Educate the patient, family, and primary caregivers about future risk factors. […] Families may worry that the patient has brain damage or a permanent psychiatric illness. Providing reassurance that delirium often is temporary and is the result of a medical condition may be beneficial to both patients and their families.

• #1 Delirium (sudden confusion) – Dementia UK

  https://www.dementiauk.org/information-and-support/health-advice/delirium/

  Delirium can be serious, so it’s vital that the person receives medical assistance as soon as possible. […] If a person is experiencing delirium, their doctor should check for underlying causes, such as signs of infection like a high temperature. […] Often, delirium gets better if the underlying problem is treated. […] About 60% of people with delirium recover within a week. Some people, however, take longer to recover, and some never get back to exactly how they were before – this is more likely if they have dementia. […] Delirium can’t always be prevented, but there are things you can do to reduce the risk.

• #1 Delirium Screening in Skilled Nursing Facilities > Health in Aging Blog > Health in Aging

  https://www.healthinaging.org/blog/delirium-screening-in-skilled-nursing-facilities/

  Delirium is a term that means sudden confusion. It is an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. Delirium is a result of abnormal functioning of the brain and requires the attention of a healthcare professional. […] Detecting delirium in the nursing home setting makes it easier for healthcare practitioners to address its underlying causes (which may include medications), and to develop a care plan to prevent complications and promote recovery. Screening for delirium also helps distinguish delirium from ADRD and is required by the Medicare program for all skilled nursing care admissions as part of a patients initial evaluation. If delirium is detected, current guidelines recommend that healthcare practitioners hold off from diagnosing ADRD until the delirium has resolved.

• #1 Delirium (sudden confusion) – Dementia UK

  https://www.dementiauk.org/information-and-support/health-advice/delirium/

  Delirium is common in people with dementia and can make them increasingly confused and distressed. Here, we explain the signs to be aware of and how you can help. […] Delirium is a state of mental confusion that comes on suddenly. It can have a big impact on the way a person behaves and functions, especially if they have dementia. […] People with delirium typically become confused and/or disorientated, and have difficulty concentrating. […] Dementia can make people more likely to experience delirium. People who are over 80 and live with dementia are at greater risk, particularly during a hospital stay, when up to 50% of people with dementia develop delirium. […] It can be difficult to recognise delirium in people with dementia because it has similar symptoms such as confusion, memory loss and problems with concentration. However, it’s important to know the signs and seek medical help quickly if you spot them.

• #1 Delirium | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/delirium/

  After recovering from delirium, theres an increased risk of dementia. People living with dementia who develop delirium may be worse after delirium. […] Delirium is very common in people in their last days of life, affecting up to half of people in this situation. Its important to identify the delirium and, where possible, consider if there are easily treatable triggers. However, the main focus of care is in managing the symptoms.

• #1 End of Life Care in Frailty: Delirium | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-delirium

  Delirium acute confusion – is important to consider at the end of life. It may be almost universal in non-sudden death, especially in those with dementia. Delirium has a poor prognosis, regardless of how well it is identified, investigated and treated, especially the hypoactive (drowsy) form. Half of those with delirium on general and geriatric medical wards will die within six months. […] Delirium causes distress due to hallucinations, delusions, exaggerated or labile emotions (anger, anxiety, fear), or incontinence. It inhibits good communication and decision-making, and relationships with families and healthcare staff; and it makes people prone to complications including falls, pressure sores, dehydration and malnutrition. Delirium can make personal and nursing care difficult if it associated with resistance or aggression.

• #1 Patients and Families Overview

  https://www.icudelirium.org/patients-and-families/overview

  What is delirium? The word delirium is used to describe a severe state of confusion. People with delirium: […] Delirium is common. About 2 out of 3 patients in ICUs get delirium. Seven out of 10 patients get delirium while they are on a breathing machine or soon after. […] Signs of delirium you may see in your family member are: […] If your loved one has delirium, you might be asked to sit and help calm them.

• #1

  https://www.caresearch.com.au/Health-Professionals/Nurses/Clinical-Care/Symptom-Management/Delirium

  Delirium is particularly prevalent in critical care and palliative care settings, and in residential aged care facilities. […] Delirium is characterised by disorientation, reduced attention and concentration, disorganised thinking and behaviour, memory deficits and, sometimes, perceptual disturbances including hallucinations or delusional beliefs. […] Delirium is potentially preventable in up to two-thirds of hospitalised patients and is often treatable. […] It is important to find and treat the cause of delirium as early as possible as it can be reversed with early detection and medical attention. […] Delirium may be reversible if it is caused by an infection, urinary retention, severe constipation, dehydration, pain, or a side effect of medication. […] As a nurse you can: keep a calm demeanour and reassure the person if they are worried or frightened; communicate clearly use short sentences and plain language, and make sure the person understands you; remind the person where they are, and what day it is; explain what is being done and why; help the person become familiar with their environment; encourage visits from people who are familiar to the person; limit change where possible; keep the person safe; encourage the person to eat and drink; support the person to avoid or manage constipation and urinary retention; encourage a good sleep routine; look out for signs of infection; check for signs that the person is in pain; help the person remain mobile; if the person is taken to hospital or a care home, help to arrange for familiar objects to accompany them; prevent complications of delirium such as immobility, falls, pressure sores, dehydration, malnourishment, isolation. […] Medicines used in the treatment of delirium include antipsychotics and benzodiazepines.

• #2 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is a fast-developing type of confusion that affects your ability to focus your attention and awareness. […] Delirium is more common in medical settings, such as during long hospital stays or in long-term care facilities. […] Delirium can often get better during the day and worse as nighttime approaches, which is why this condition sometimes gets the incorrect name of sundowning. […] Delirium is often preventable, but most preventive measures are things only clinical personnel should do. […] However, family, friends and loved ones can play a very important role in reducing the risk of delirium. […] Healthcare providers will treat causes and contributing factors they can identify. Helping people with mobility and activity or removing tethers can help delirium get better. […] Monitoring and adjusting medications can also help improve delirium while you undergo treatment for the underlying causes.

• #2 Delirium | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/delirium

  Delirium is a serious medical syndrome characterized by acute confusion, disoriented thinking, and cognitive disturbances, including hallucinations and delusions. […] Delirium is most commonly observed in hospital settings, especially among critically ill patients, where it affects approximately 80% of those in intensive care. […] Family support plays a crucial role in the care of patients experiencing delirium, as it can be distressing for relatives to witness changes in behavior and cognition. […] Understanding delirium is vital for improving patient care and family coping mechanisms in medical settings. […] Delirium is the name given to a set of symptoms that include severe confusion and disoriented thinking and often incorporate delusions and hallucinations. […] The onset is sudden, and can begin for the patient in the span of hours or even minutes.

• #2 Delirium | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/delirium

  Delirium is also a primary predictor of death within a year for those patients experiencing it in critical care settings. […] The disturbance of conscious mental functions and changes in cognition are often the first indication that delirium is underway. […] Disorientation, agitation, and overly complex thinking are also prime indicators of delirium onset. […] If patients are elderly, face multiple comorbidities, are dependent on others, and are dehydrated, the chance of delirium is higher. […] The outcomes for delirium are negative and include death, more health interventions (cost and pain), and increased length of stay in the intensive care unit or other hospital unit. […] Nearly half of all cancer patients receiving palliative care have delirium upon admission, while 88 percent of dying cancer patients demonstrate the syndrome.

• #2 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium is an acute disturbance in a persons attention, awareness and cognition that can be caused by an acute medical condition or medication changes. Delirium is serious and may be the only sign of a deteriorating patient. […] Delirium should be treated as a medical emergency. […] Delirium can often be prevented and can be treated and managed. As clinicians we must listen to the families of our patients when they tell us the person seems confused. […] We must recognise and respond to delirium as we would any other medical emergency. […] Delirium develops quickly and symptoms fluctuate throughout the day. […] Delirium can be hyperactive, hypoactive (quiet delirium) or mixed. […] Delirium develops quickly, over hours or days, and symptoms fluctuate throughout the day and are often worse at night.

• #2 8 Important Nursing Assessments for the Patient with Confusion | Medbridge

  https://www.medbridge.com/blog/eight-important-nursing-assessments-for-the-patient-with-confusion

  The patient with confusion often presents a challenge for the nurse. Many are quick to dismiss the confusion, regarding the patient as cute or saying they’re always confused, or they just have Alzheimers. But beware! These types of reactions on the part of the staff may actually be signs of ageism or infantilizing and do not meet nursing professional standards of care. The licensed nurse is held to a higher standard of practice than this and is responsible to fully assess their confused patients in order to decide how to best handle their care. […] A patient with new onset confusion should always be reported to the physician. Communicate your assessment to the physician, and expect orders for labs, x-rays, and/or medication depending upon the situation. Communicate your findings to other staff, and initiate a plan of care to address the patient’s unique issues.

• #2 Acute Confusion (Delirium) Nursing Diagnosis & Care Plan – Nurseslabs

  https://nurseslabs.com/acute-confusion/

  After a thorough assessment, a nursing diagnosis is formulated to address acute confusion based on the nurses clinical judgment and the patients unique condition. […] The nursing assessment for acute confusion involves gathering information on the patients cognitive function, medical history, medication use, and potential contributing factors to identify the underlying cause of confusion and develop an effective care plan. […] The nursing interventions for managing confusion and delirium aims to manage and treat the underlying cause of confusion, promote patient safety, optimize cognitive function, and educate patients and families on strategies to prevent or manage future episodes of acute confusion. […] Early intervention prevents long-term complications. Because delirious clients are often confused and unable to provide accurate information, getting a detailed history from family and caregivers is particularly important. Delirium should always be suspected when a new onset or an acute or subacute deterioration in behavior, cognition, or function occurs, especially in clients who are older adults, demented or depressed.

• #2 Delirium (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568723/

  Delirium, also known as an acute confessional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of attention, consciousness, and cognition, with a reduced ability to focus, sustain or shift attention. It develops over a short period of time and fluctuates during the day. The clinical presentation can vary, usually demonstrating psychomotor behavioral disturbances such as hyperactivity or hypoactivity and with impairment in sleep duration and architecture. […] Delirium is dangerous, often preventable, and associated with a significant cost burden and increased morbidity and mortality. Efforts should focus on prevention, early detection, and treatment of the underlying cause. This activity reviews the evaluation and management of delirium and the role of interprofessional team members in collaborating to provide well-coordinated care and improve patient outcomes.

• #2 Sudden confusion (delirium)

  https://www.nhs.uk/conditions/confusion/

  Sudden confusion (delirium) can have many different causes. Get medical help immediately if someone suddenly becomes confused (delirious). […] Many causes of sudden confusion need to be assessed and treated as soon as possible. Sometimes it may be life threatening. […] Sudden confusion can be caused by many different things. Do not try to self-diagnose. Get medical help if someone suddenly becomes confused or delirious.

• #2 Acute Confusion Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/acute-confusion-nursing-diagnosis-care-plan/

  Acute confusion is an abrupt disruption in consciousness, attention, cognition, and perception. It is reversible and is a symptom of an underlying condition. The nurses role in acute confusion is to first ensure patient safety. Patients experiencing hallucinations, decreased consciousness, paranoia or anxiety are a safety risk to themselves and others. Along with implementing treatment and assessing for new or worsening confusion the nurse applies therapeutic interventions to relax the patient and provide a calming environment. […] The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to acute confusion. […] Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with acute confusion. […] Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care.

• #2 Delirium: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/delirium-nursing-diagnosis-care-plan/

  Expected outcomes: Patient will demonstrate appropriate orientation to person and place. Patient will cooperate with care and assessments. Patient will communicate needs and follow commands. […] Assess electrolytes and other laboratory test results. Abnormalities such as metabolic alkalosis, hyponatremia, hypoglycemia, or any signs of infection can signal an underlying cause of delirium. […] Reorient the patient as needed. Help to maintain reality and prevent anxiety by orienting to place and time as needed. […] Treat the underlying cause. An infection may require antibiotics. Severe pain can be treated with opioids. Alcohol withdrawal is treated with anti-anxiety medications. Dehydration requires fluid resuscitation and supplemental electrolytes. […] Impaired social interaction can happen in patients experiencing delirium due to altered thinking and inappropriate behavior.

• #2 Delirium: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/delirium-nursing-diagnosis-care-plan/

  Familiarize them with their environment. Hospitalization, especially for long durations or associated with surgery or ICU admission, increases the incidence of delirium. […] Risk for Self-Mutilation […] Nursing Diagnosis: Risk for Self-Mutilation […] Expected outcomes: Patient will refrain from harming themself and remain free from any injuries. Patient will maintain self-control without the use of restraints or 24/7 supervision. […] Manage the underlying cause. Instances of self-mutilation related to delirium are often unintentional since the patient is not thinking clearly. […] Calm and soothe. Some patients, especially older adults experiencing delirium, may respond to calming music, hair brushing, or other types of therapeutic touch to reduce self-injurious behaviors. […] Risk for Suicide

• #2 Delirium: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/delirium-nursing-diagnosis-care-plan/

  Nursing Diagnosis: Impaired Social Interaction […] Expected outcomes: Patient will respond appropriately to questions. Patient will participate in a group setting within their capabilities. […] Ensure that medications are taken as prescribed. Some patients may not take medications correctly, either overdosing or underdosing. […] Provide a calm environment. Allow the patient to interact with familiar faces by providing an isolated, quiet, and nonstimulating environment. […] Risk for Injury […] Nursing Diagnosis: Risk for Injury […] Expected outcomes: Patients family will implement strategies to reduce the risk of injury. Patient will remain free of injury. […] Remain with the patient when agitated or combative. Staff may need to remain at a distance to prevent injury to themselves, but remaining at the bedside may be necessary to prevent the patient from injuring themselves. Restraints are considered as a last resort.

• #2 Caring for Someone With Delirium | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/delirium

  Delirium is a sudden (quick) change in the way a person thinks and acts. People with delirium cannot pay attention to whats going on around them, and their thinking is not clear. This can be scary for the person with delirium, their family, caregivers, and friends. […] If the person shows any of signs of delirium, tell their healthcare provider right away. The persons care team will take care of them and refer them to other services, if needed. […] The best way to treat delirium is to find and treat the thing thats causing it. Sometimes, the persons healthcare provider may need to order many tests to find the cause of the delirium. […] In addition to medication, other things can help treat someone with delirium. The persons care team may take certain medical equipment out of their hospital room if its not needed. This can help the person feel safer. They may also have someone stay in the room with the person, such as a nursing assistant. They can help make sure the person stays safe.

• #2 Confusion and Delirium | Cancer-related Side Effects | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/changes-in-mood-or-thinking/confusion.html

  Confusion and delirium affect how a person thinks and behaves. When someone is confused or delirious, they can’t think clearly and might not behave like they usually do. It most often goes away, but can be a sign that something serious is wrong. […] Delirium affects memory and thinking. It is a more severe kind of confusion. It changes the way a person behaves and sees the world around them. Delirium comes on quickly and will often resolve after the cause is treated. […] Treatment for delirium and confusion depends on the cause. Many times, treating the cause will ease or get rid of delirium or confusion. The cancer care team will do an assessment to look at any physical causes or medicines that might be causing the confusion or delirium. […] Not all causes of delirium and confusion can be treated. This is often true when a person is nearing the end of their life. In that case, making the person comfortable may be the best option.

• #2 Confusion and Delirium | Cancer-related Side Effects | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/changes-in-mood-or-thinking/confusion.html

  Caring for someone who is confused or has delirium can be hard. Changes in how they behave might make family and friends anxious or afraid. […] The type of care that your loved one needs will depend on how confused they are and other symptoms they may have. Here are some things you can do to help keep your loved one safe and as comfortable as possible. […] Many people have confusion and delirium at the end of their life. Some people believe that hallucinations at the end of life are part of the dying process. Treatment may not be needed if the hallucinations are not upsetting. […] There are medicines that can make a person with confusion or delirium more comfortable. The cancer care team may suggest sedation if a person is very agitated and not getting better with other treatments. Sedation can make the person who is dying more comfortable.

• #2 Alzheimer’s Disease and Delirium: Guidance and Tips

  https://www.webmd.com/alzheimers/confusion-delirium

  Its normal for people with Alzheimers disease to feel more confused as time passes. But sometimes this confusion gets worse very quickly, over a matter of hours or days. If this happens with your loved one, take them to a doctor as soon as possible to be sure that its not delirium. […] Since delirium is usually caused by a health problem, its important to talk with your loved ones doctor about finding the reason for it and to follow any treatment instructions. […] You also can do a few things to help manage delirium: Talk to your loved one calmly. Make eye contact. If theyll let you, use a gentle touch. Give simple, clear instructions. Tell them often what day it is, what time it is, where they are, and who the people around them are. If theyve had Alzheimers disease for a while, reminders may not help. If your loved one seems upset by them, try to just go along with whatever they say or believe. When you do things to take care of them, remind them who you are and tell them what youre about to do. Help them remember the time, date, where they are, and what theyre doing. It helps to use something they can see, like a clock or watch, calendar, or daily schedule. Keep the area around them familiar and calm. Lower loud, distracting noises, such as phones or loud TVs, but dont have complete silence. You may want to softly play their persons favorite music or TV show. Put on soft lighting. Try a 40- to 60-watt night light. Try to keep your homes temperature between 70 and 75 F. Stay away from very high or low temperatures, inside or outside. Have family and other familiar people spend time with them, but dont have too many visitors at once. Try to stick to a structured routine. Make sure your loved one drinks enough fluids. Encourage them to get up and walk around. Provide help if needed. If they need glasses, a hearing aid, or dentures, try to make sure they wear them. Check that their glasses are clean and the right ones for the distance. Make sure their hearing aid works and is turned on.

• #2 Delirium – symptoms, diagnosis and treatment | Alzheimer’s Society

  https://www.alzheimers.org.uk/get-support/daily-living/delirium

  A supportive and calm environment can also help someone recover from delirium. Healthcare professionals, family and friends can all help a person by: talking calmly in short clear sentences, reminding them where they are and who you are, bringing familiar objects from home, such as photographs, helping them to eat and drink regularly, making sure glasses and hearing aids are clean and working properly, and that they are wearing them, setting up a 24-hour clock and calendar that they can see clearly, helping them get into a healthy sleep routine, providing reassurance if they have distressing hallucinations or delusions, supporting them to get up and about, as soon as its safe to do so, not taking them to new environments that are unfamiliar, busy or confusing. […] For many people the symptoms of delirium usually improve in a few days, once the underlying causes have been treated. However, some people dont make a quick or full recovery and may still be having problems with memory and thinking several weeks or even months after becoming unwell.

• #2 Temporary Confusion & Disorientation (Delirium): Causes & Treatment

  https://www.webmd.com/brain/sudden-confusion-causes

  Once doctors can get the cause under control, the confusion usually goes away. It can take hours or days to recover, sometimes longer. In the meantime, some people may need medication to keep them calm and help with their confusion. […] As the person gets better, it may help to: Make sure they get enough to eat and drink. Encourage them to move around (with your help). Get them on a normal sleep schedule. Surround them with comforting and familiar objects (like family photos). Dont overwhelm them with too much noise or too many visitors, but dont isolate them either.

• #2 Tip Sheet: Managing Delirium in Older Adults | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/tip-sheet-managing-delirium-older-adults

  Many hospitals allow family members or friends to stay overnight in the hospital room. […] Try to provide calm reassurance and comfort. […] Being there for mealtimes is also important and supports better food and liquid intake. […] Help the older person remember where they are. […] You can gently and calmly explain why he or she is in the emergency room, hospital, or other facility. […] Offer frequent, simple explanations of what is happening and of any changes in routine. […] Encourage physical activity, games, and conversation. […] Simple games, quiet conversation, or other pastimes the person enjoys are also helpful. […] Its important for all healthcare providers to know all the medications an older person is taking, along with the dosages. […] Having this information written down and on hand is always helpful for an older person, particularly if they are taken to the emergency room. […] In addition to the above steps, delirium can often be reversed by treating some of the common causes. […] You can discuss these with the older persons healthcare providers.

• #2 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  Delirium (sudden confusion) usually affects peoples brains for a short time. It is a common condition. Up to 1 in 3 people admitted to hospital become delirious at some time during their stay. […] Depending on how bad the delirium is, a person may need to go into hospital for treatment and management. For others, delirium can be treated at home. […] Family members and carers have an important role. They can help to manage delirium in hospital or at home. […] In hospital, you can tell the nurse or doctor looking after the person about the symptoms you have noticed. At home, you can talk to a GP. […] Some people with delirium need to come into hospital to manage the condition or what is causing it. […] Sometimes, we give the person with delirium calming or sedating medicines. We use these medicines if the person is still distressed or unsafe after we have tried other ways to keep them calm.

• #2 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Assessment for and prevention of delirium should occur at admission to the hospital and throughout the stay. […] Nonpharmacologic prevention strategies consist of orientation and therapeutic activities, early and recurrent mobilization, minimizing the use of psychoactive medications, promoting normal sleep-wake cycles, providing easy access to adaptive equipment for sensory impairment (e.g., glasses, hearing aids), and preventing dehydration. […] Once delirium is diagnosed in an inpatient setting, it is important to identify and treat the underlying causes. After the causative factors are addressed, focus should shift to nonpharmacologic measures, providing supportive care, and preventing complications. […] Pharmacologic therapy should be reserved for patients who are a threat to their own safety or the safety of others. By convention, haloperidol has been the agent of choice for treatment of delirium, despite a higher incidence of extrapyramidal adverse effects.

• #2 Abrupt change in mental status | HIGN

  https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

  Delirium, or acute confusion, is a common condition in older adults affecting up to 30% of all patients over age 65 admitted to the hospital. Delirium is characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time. While this condition is largely preventable, it often goes unrecognized by clinicians and is subsequently poorly managed. Older adults are at increased risk of developing delirium, as are patients with dementia, severe illness, physical frailty, infection or dehydration, polypharmacy, visual impairment, hip fracture, recent surgery, excessive alcohol consumption, and renal impairment. Causes of delirium frequently include underlying medical conditions such as infection and electrolyte imbalances, and drug intoxication and withdrawal. Once delirium has developed, patients tend to have increased length of stay, increased mortality and increased risk of institutional placement.

• #2 Delirium and acute confusional states: Prevention, treatment, and prognosis – UpToDate

  https://www.uptodate.com/contents/delirium-and-acute-confusional-states-prevention-treatment-and-prognosis

  Delirium is an acute confusional state characterized by an alteration of consciousness with reduced ability to focus, sustain, or shift attention. This results in a cognitive or perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia. Delirium develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. Delirium is typically caused by a medical condition, substance intoxication, or medication side effect. […] The management of delirium is based primarily upon expert consensus and observational studies, and only a small number of controlled clinical trials, which are difficult to perform in patients with cognitive impairment. The preponderance of evidence is most compelling for primary prevention of delirium using nonpharmacologic, multicomponent approaches targeted broadly at high-risk patients. Prevention and therapy of delirium are based on the following principles: […] Avoiding factors known to cause or aggravate delirium, such as multiple medications, dehydration, immobilization, sensory impairment, and disruption of the sleep-wake cycle. […] Identifying and treating the underlying acute illness.

• #2 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/delirium-and-dementia/delirium

  To help prevent delirium in an older adult during a hospital stay, family members can ask hospital staff members to help by doing the following: Encouraging the person to move around regularly, Placing a clock and calendar in the room, Minimizing the interruptions and noises during the night, Making sure the person eats and drinks enough. […] Most people who have delirium are hospitalized. However, when the cause of delirium can be corrected readily (for example, when the cause is low blood sugar), people are observed for a short time in the emergency department and can then return home. […] Once the cause is identified, it is promptly corrected or treated. For example, doctors treat infections with antibiotics, dehydration with fluids and electrolytes given intravenously, and delirium due to stopping alcohol with benzodiazepines.

• #2 Abrupt change in mental status | HIGN

  https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

  In all health care systems, providers and nurses would benefit from staff training by geriatric psychiatrists and specialists to recognize and differentiate symptoms of delirium from dementia. This knowledge is essential to prevent and manage abrupt change in mental status in older adults. Staff should also educate family members and caregivers to identify symptoms of delirium that warrant intervention by the interprofessional team. Considering that many older adults have atypical symptoms of delirium, a family members complaint that a patient is not him/herself should never be taken lightly. Efforts to educate the public about the prevalence of delirium and its risk factors for older adults will also help to address the under-recognition of delirium and its mismanagement in the clinical setting.

• #2 Tip Sheet: Managing Delirium in Older Adults | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/tip-sheet-managing-delirium-older-adults

  Delirium is a sudden change in mental status that can be caused by a number of factors. […] Many factors can contribute to delirium, including acute illness, surgery, and medications. […] When delirium isnt recognized, it can delay an older persons recovery. […] Prolonged delirium can have a lasting impact on an older persons health and well-being. […] Delirium can start to happen in just a few hours. […] As a friend or family member, you know the older person better than the hospital staff, so you are often the first person to see signs of delirium. […] Be sure to report your concerns right away. […] Since you know the older person best, you can quickly pick up on changes in their mental state. […] Tell the healthcare staff right away if you notice anything unusual. […] Friends and family offer comfort and familiarity.

• #2 Caring for Someone With Delirium | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/delirium

  There are many ways you can help someone with delirium, such as: Having a regular day and night schedule for them and helping them keep a normal sleep pattern. […] It can be hard to talk to someone with delirium, but its important to be patient and understanding. […] The persons doctor, nurse, social worker, and case manager will help you plan for their care at home. Call their doctor or nurse if you have any questions or concerns.

• #2 Abrupt change in mental status | HIGN

  https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

  For patients presenting with abrupt change in mental status on admission, family members can provide essential information about the onset and course of symptoms as part of the patients history to help providers distinguish between delirium and dementia. The most important action for the management of delirium is identifying and treating the underlying cause of symptoms, such as dehydration, hypoxemia, and hypoglycemia. If patient has been taking anticholinergic and psychoactive drugs, providers and pharmacists should consider whether these medications can be reduced or discontinued. Non-pharmacological approaches to managing anxiety and promoting sleep and relaxation, such as massage, music, and warm beverages, are encouraged. Family member and companion involvement in reorienting and comforting patient is also helpful. Providers should refrain from placing patients with delirium on bedrest and instead encourage mobility and patient involvement in self-care activities. It is important that patients have access to all sensory assistive devices, such as glasses, hearing aids, and dentures, to improve sensation and perception and reduce risk of disorientation and agitation. Nurses may be assigned to work with agitated patients with delirium on a one-to-one basis to maintain safety and reduce need for physical restraints. Pharmacological interventions should be used only in severely agitated patients at risk of self-harm or those with distressing psychotic symptoms such as hallucinations and delusions. Consultation with geriatric psychiatrists and pharmacists will be useful in determining appropriate interventions for these patients such as administration of haloperidol for severe agitation.

• #2 Delirium (sudden confusion) – How to help someone with delirium | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion/how-help-someone-delirium

  It can be distressing to see someone that you know with delirium. There are things that family, friends and carers can do to help people when they are delirious. […] Your contribution to the person’s delirium care is important. As you know the person best, you can help our staff to understand who they are and what might work for them. […] Please also tell us if the person is a heavy smoker or drinker, or regularly uses sleeping pills or sedatives (calming medicines). Sometimes withdrawal from these things can make delirium worse. The person may need specific treatments. […] It is important that the person with delirium eats and drinks well. We try to supervise mealtimes if needed. However, if the person has any favourite foods or finds some foods comforting, you can bring them to the hospital.

• #2 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  When a person leaves hospital after delirium, they may need more support than usual. They may be at higher risk of falls and need some changes in the home to make sure that their environment is safe. […] We try to make sure that people get the right level of support when they leave hospital. This includes rehabilitation to improve, restore and maintain their everyday skills and mobility.

• #2 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics/print

  The goal of supportive care is to maintain the patient’s health, prevent additional complications, and avoid those factors that can aggravate delirium. […] Delirium has an enormous impact upon the health of older people. Patients with delirium may experience prolonged hospitalizations and a decreased ability to function independently, and are at high risk for requiring care in a long-term care facility (eg, nursing home). […] Even patients that appear to have recovered from delirium may have trouble remembering medications and self-care instructions.

• #2 Delirium (sudden confusion) – Dementia UK

  https://www.dementiauk.org/information-and-support/health-advice/delirium/

  Delirium can be serious, so it’s vital that the person receives medical assistance as soon as possible. […] If a person is experiencing delirium, their doctor should check for underlying causes, such as signs of infection like a high temperature. […] Often, delirium gets better if the underlying problem is treated. […] About 60% of people with delirium recover within a week. Some people, however, take longer to recover, and some never get back to exactly how they were before – this is more likely if they have dementia. […] Delirium can’t always be prevented, but there are things you can do to reduce the risk.

• #2 8 Important Nursing Assessments for the Patient with Confusion | Medbridge

  https://www.medbridge.com/blog/eight-important-nursing-assessments-for-the-patient-with-confusion

  Remember that a patient with well-known, long-term confusion can have delirium (acute onset confusion) as well as dementia at the same time. Do not dismiss the patient with a diagnosis of dementia, Alzheimer’s, or brain injury as simply being „confused as always.” Today, their confusion may be different than the day or week prior, and it may be more dangerous. The nurse’s role is to look beyond the diagnosis of dementia and prevent an acute situation from worsening. […] As nurses, we must prioritize providing a full assessment to the confused patient. We are among those who can prevent hospitalization and even save a life.

• #2 Delirium (sudden confusion) – Dementia UK

  https://www.dementiauk.org/information-and-support/health-advice/delirium/

  Delirium is common in people with dementia and can make them increasingly confused and distressed. Here, we explain the signs to be aware of and how you can help. […] Delirium is a state of mental confusion that comes on suddenly. It can have a big impact on the way a person behaves and functions, especially if they have dementia. […] People with delirium typically become confused and/or disorientated, and have difficulty concentrating. […] Dementia can make people more likely to experience delirium. People who are over 80 and live with dementia are at greater risk, particularly during a hospital stay, when up to 50% of people with dementia develop delirium. […] It can be difficult to recognise delirium in people with dementia because it has similar symptoms such as confusion, memory loss and problems with concentration. However, it’s important to know the signs and seek medical help quickly if you spot them.

• #2 End of Life Care in Frailty: Delirium | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-delirium

  Delirium acute confusion – is important to consider at the end of life. It may be almost universal in non-sudden death, especially in those with dementia. Delirium has a poor prognosis, regardless of how well it is identified, investigated and treated, especially the hypoactive (drowsy) form. Half of those with delirium on general and geriatric medical wards will die within six months. […] Delirium causes distress due to hallucinations, delusions, exaggerated or labile emotions (anger, anxiety, fear), or incontinence. It inhibits good communication and decision-making, and relationships with families and healthcare staff; and it makes people prone to complications including falls, pressure sores, dehydration and malnutrition. Delirium can make personal and nursing care difficult if it associated with resistance or aggression.

• #2 End of Life Care in Frailty: Delirium | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-delirium

  Estimates are difficult, but up to half of delirium at the end of life can be alleviated. Judicious clinical judgement is required, avoiding investigation and treatment burden, taking into account the anticipated proximity of death and chances of recovery. […] Distressing symptoms can be treated with drugs via the oral, transdermal or parenteral (subcutaneous) routes. This will include antipsychotic drugs if necessary (although the evidence for effectiveness is weak). These are also effective for anxiety. Benzodiazepines potentially worsen delirium, and should be avoided, but are needed in some situations including alcohol withdrawal, dementia with Lewy bodies or cases of immediate and grave harm where rapid tranquillisation is needed.

• #2 Delirium: Definition, Causes, and What It Feels Like

  https://www.verywellhealth.com/delirium-5223127

  Delirium is a sudden change in how a person thinks, making them feel confused or disoriented. […] Delirium causes sudden confusion and trouble thinking clearly. […] Delirium symptoms usually come on suddenly and may come and go over the course of a day. […] Delirium is particularly common among people over 80. […] Delirium may be an early warning sign of dementia, especially in older adults recovering from hospitalization. […] If you notice any signs of delirium in yourself or a loved one, seek immediate medical care. […] Treatment focuses on addressing the underlying cause and creating a safe, calming environment, with medication used in severe cases.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Delirium-Symptoms.aspx

  Delirium is a sudden state of severe mental confusion that can occur as a result of illness, surgery or the use of some medications. […] Delirium is present in about 15 to 20% of patients who are admitted to hospital. […] Although these facts are known, delirium is still underdiagnosed and inadequately managed, with as many as two thirds of cases being overlooked in some healthcare settings. […] For critically ill patients, clinicians can use the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to detect delirium and this tool is particularly useful for patients on mechanical ventilation. […] Another diagnostic tool that may be used in the ICU setting is the Intensive Care Delirium Screening Checklist (ICDSC).

• #2 Delirium: Prevent, Identify, Treat | ANA Enterprise

  https://www.nursingworld.org/practice-policy/work-environment/health-safety/delirium/

  Evidence-based management of delirium requires an individualized, multi-component approach. An interdisciplinary approach to prevent, manage, and treat delirium is essential. […] This website has been created for the practitioner to be able to access high quality, evidence-based resources. It is our hope that the user will apply this information to improve the quality of care and the quality of life of those affected.

• #2 Acute Confusional States in the Elderly—Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3371633/

  Delirium is common, has multiple causes and causes distress to numerous patients and their relatives. […] The hypoactive subtype of delirium is commoner than the hyperactive type, and often overlooked. Delirium in an elderly individual is associated with an additional burden, a possible loss of potential for rehabilitation, and a marked increase in mortality. The diagnosis of delirium is primarily clinical. All professionals involved in patient care must be able to recognize the features of delirium. […] Rehabilitation strategies should be initiated without delay. Neuroleptics and benzodiazepines have an established role in the pharmacological treatment even of the hyperactive subtype. Non-pharmacological treatments include the creation of a calm and patient centred environment, and the involvement of relatives.

• #3 Caring for Someone With Delirium | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/delirium

  Delirium is a sudden (quick) change in the way a person thinks and acts. People with delirium cannot pay attention to whats going on around them, and their thinking is not clear. This can be scary for the person with delirium, their family, caregivers, and friends. […] If the person shows any of signs of delirium, tell their healthcare provider right away. The persons care team will take care of them and refer them to other services, if needed. […] The best way to treat delirium is to find and treat the thing thats causing it. Sometimes, the persons healthcare provider may need to order many tests to find the cause of the delirium. […] In addition to medication, other things can help treat someone with delirium. The persons care team may take certain medical equipment out of their hospital room if its not needed. This can help the person feel safer. They may also have someone stay in the room with the person, such as a nursing assistant. They can help make sure the person stays safe.

• #3 Delirium: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/delirium-nursing-diagnosis-care-plan/

  Nursing Diagnosis: Risk for Suicide […] Expected outcomes: Patient will remain safe and will not harm themself. Patient will not obtain access to a weapon. […] Monitor for changes in behavior or mood that signal an increasing suicide risk. […] Provide orientation and reassurance to the patient. Patients who are delirious are often confused, and frequent reorientation can help reduce their stress and anxiety, which can significantly reduce the risk of suicidal behavior.

• #3 Tip Sheet: Managing Delirium in Older Adults | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/tip-sheet-managing-delirium-older-adults

  Many hospitals allow family members or friends to stay overnight in the hospital room. […] Try to provide calm reassurance and comfort. […] Being there for mealtimes is also important and supports better food and liquid intake. […] Help the older person remember where they are. […] You can gently and calmly explain why he or she is in the emergency room, hospital, or other facility. […] Offer frequent, simple explanations of what is happening and of any changes in routine. […] Encourage physical activity, games, and conversation. […] Simple games, quiet conversation, or other pastimes the person enjoys are also helpful. […] Its important for all healthcare providers to know all the medications an older person is taking, along with the dosages. […] Having this information written down and on hand is always helpful for an older person, particularly if they are taken to the emergency room. […] In addition to the above steps, delirium can often be reversed by treating some of the common causes. […] You can discuss these with the older persons healthcare providers.

• #3 Alzheimer’s Disease and Delirium: Guidance and Tips

  https://www.webmd.com/alzheimers/confusion-delirium

  Its normal for people with Alzheimers disease to feel more confused as time passes. But sometimes this confusion gets worse very quickly, over a matter of hours or days. If this happens with your loved one, take them to a doctor as soon as possible to be sure that its not delirium. […] Since delirium is usually caused by a health problem, its important to talk with your loved ones doctor about finding the reason for it and to follow any treatment instructions. […] You also can do a few things to help manage delirium: Talk to your loved one calmly. Make eye contact. If theyll let you, use a gentle touch. Give simple, clear instructions. Tell them often what day it is, what time it is, where they are, and who the people around them are. If theyve had Alzheimers disease for a while, reminders may not help. If your loved one seems upset by them, try to just go along with whatever they say or believe. When you do things to take care of them, remind them who you are and tell them what youre about to do. Help them remember the time, date, where they are, and what theyre doing. It helps to use something they can see, like a clock or watch, calendar, or daily schedule. Keep the area around them familiar and calm. Lower loud, distracting noises, such as phones or loud TVs, but dont have complete silence. You may want to softly play their persons favorite music or TV show. Put on soft lighting. Try a 40- to 60-watt night light. Try to keep your homes temperature between 70 and 75 F. Stay away from very high or low temperatures, inside or outside. Have family and other familiar people spend time with them, but dont have too many visitors at once. Try to stick to a structured routine. Make sure your loved one drinks enough fluids. Encourage them to get up and walk around. Provide help if needed. If they need glasses, a hearing aid, or dentures, try to make sure they wear them. Check that their glasses are clean and the right ones for the distance. Make sure their hearing aid works and is turned on.

• #3 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Context-specific, nonpharmacologic interventions for delirium are still advised in this setting, but tranquilizers, such as haloperidol or atypical antipsychotics, are often required. […] A meta-analysis found that delirium in hospitalized older persons was associated with increased mortality, regardless of confounders such as age, sex, and comorbidities.

• #3 Delirium Screening in Skilled Nursing Facilities > Health in Aging Blog > Health in Aging

  https://www.healthinaging.org/blog/delirium-screening-in-skilled-nursing-facilities/

  They concluded that among older adults without evidence of dementia, a positive test for delirium upon their admittance to a skilled nursing facility is strongly linked to the risk for a new ADRD diagnosis. This risk of receiving an ADRD diagnosis was highest immediately after a positive test for delirium, and among patients with the least cognitive impairment. Study findings suggest there is the potential for premature or inappropriate diagnosis of ADRD among older adults admitted to skilled nursing facilities with delirium.

• #3 Confusion and Delirium | Cancer-related Side Effects | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/changes-in-mood-or-thinking/confusion.html

  Caring for someone who is confused or has delirium can be hard. Changes in how they behave might make family and friends anxious or afraid. […] The type of care that your loved one needs will depend on how confused they are and other symptoms they may have. Here are some things you can do to help keep your loved one safe and as comfortable as possible. […] Many people have confusion and delirium at the end of their life. Some people believe that hallucinations at the end of life are part of the dying process. Treatment may not be needed if the hallucinations are not upsetting. […] There are medicines that can make a person with confusion or delirium more comfortable. The cancer care team may suggest sedation if a person is very agitated and not getting better with other treatments. Sedation can make the person who is dying more comfortable.

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