In-hospital delirium risk assessment, diagnosis and management; medications to avoid
Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. <br />In-hospital risk assessment and diagnosis: Ag...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2013-03-01
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| Series: | Italian Journal of Medicine |
| Subjects: | |
| Online Access: | http://www.italjmed.org/index.php/ijm/article/view/133 |
| _version_ | 1797429536814530560 |
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| author | Andrew Clegg John Young |
| author_facet | Andrew Clegg John Young |
| author_sort | Andrew Clegg |
| collection | DOAJ |
| description | Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. <br />In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. <br />In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. <br />Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H<sub>1</sub> antagonists for people at risk of delirium and considered individual patient assessment is advocated. <br />Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at risk of delirium will help guide evidence-based decision making. |
| first_indexed | 2024-03-09T09:14:34Z |
| format | Article |
| id | doaj.art-1bb1e1de373d455d8d81e8c873918282 |
| institution | Directory Open Access Journal |
| issn | 1877-9344 1877-9352 |
| language | English |
| last_indexed | 2024-03-09T09:14:34Z |
| publishDate | 2013-03-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Italian Journal of Medicine |
| spelling | doaj.art-1bb1e1de373d455d8d81e8c8739182822023-12-02T07:23:02ZengPAGEPress PublicationsItalian Journal of Medicine1877-93441877-93522013-03-01529810210.4081/itjm.2011.98107In-hospital delirium risk assessment, diagnosis and management; medications to avoidAndrew CleggJohn YoungBackground: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. <br />In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. <br />In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. <br />Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H<sub>1</sub> antagonists for people at risk of delirium and considered individual patient assessment is advocated. <br />Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at risk of delirium will help guide evidence-based decision making.http://www.italjmed.org/index.php/ijm/article/view/133DeliriumAcute confusionMedicationsDrugsPrevention. |
| spellingShingle | Andrew Clegg John Young In-hospital delirium risk assessment, diagnosis and management; medications to avoid Italian Journal of Medicine Delirium Acute confusion Medications Drugs Prevention. |
| title | In-hospital delirium risk assessment, diagnosis and management; medications to avoid |
| title_full | In-hospital delirium risk assessment, diagnosis and management; medications to avoid |
| title_fullStr | In-hospital delirium risk assessment, diagnosis and management; medications to avoid |
| title_full_unstemmed | In-hospital delirium risk assessment, diagnosis and management; medications to avoid |
| title_short | In-hospital delirium risk assessment, diagnosis and management; medications to avoid |
| title_sort | in hospital delirium risk assessment diagnosis and management medications to avoid |
| topic | Delirium Acute confusion Medications Drugs Prevention. |
| url | http://www.italjmed.org/index.php/ijm/article/view/133 |
| work_keys_str_mv | AT andrewclegg inhospitaldeliriumriskassessmentdiagnosisandmanagementmedicationstoavoid AT johnyoung inhospitaldeliriumriskassessmentdiagnosisandmanagementmedicationstoavoid |