DELIRIUM. Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine
|
|
- Claribel Ward
- 6 years ago
- Views:
Transcription
1 DELIRIUM Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine
2 Disclosure Milliman Care Guidelines - Editor
3 Objectives Define delirium Epidemiology Diagnose Prevent Treat Counsel
4 Define Delirium Acute state of confusion Sudden onset Progresses during several hours to days Fluctuating course Can alternate between agitation/restlessness and fatigue/indifference Inattention Hallmark of diagnosis forgetful, confused Abnormal level of consciousness at times Hypoactive delirium (25%) Fatigued Hyperactive delirium (25%) Hallucinations Agitated Mixed (50%)
5 AKA Acute confusional state Toxic encephalopathy Organic brain syndrome ICU psychosis
6 In patients aged 70 and older General Medical Inpatient Ward 17% No Delirium 17% 66% Present on Admission Develops during Admission
7 Epidemiology Up to 75% of patients in an ICU Up to 85% at the end of life
8 Important? In the Hospital: Up to ten times the risk of mortality Three to five times the risk of a nosocomial infection Prolonged length of stay Greater chance of nursing home discharge as opposed to a home discharge (73% vs 30% in one study) Increased costs estimated at $ Billion annually
9 After Discharge Once thought to be an acute problem that resolved Prolonged risk for mortality lasts for up to 2 years At risk for poor functional and cognitive recovery
10 Post-operative delirium Saczynski JS et al. N Engl J Med 2012;367:30-39
11 Challenging to Diagnose Index of suspicion Agitation present in less than 25% of cases 50-80% of cases remain undiagnosed Screening SQiD (single question in delirium) Do you think [insert pt name] has been more confused lately? 80% sensitive and 71% specific in hospitalized oncology patients
12 Differential Diagnosis Sundowning If it is a new pattern, assume delirium Established sundowning can be worse in the hospital Neurologic (focal) Wernicke s aphasia Bifrontal lesions Nonconvulsive status epilepticus Facial twitching Nystagmus Automatisms Psychiatric diagnosis Depression Dementia
13 Delirium vs. Dementia Why is it difficult to differentiate? Often co-exist Dementia with Lewy bodies can be associated with fluctuations in mental status and visual hallucinations
14 Delirium vs. Dementia Onset and course Dementia slow onset over months or years Delirium sudden onset over hours or days Speech normal slurred inattentive, easily Attention normal distracted Memory gradual memory loss more forgetful than usual Hallucinations possible common Mood normal or depressed anxious, fearful, suspicious, indifferent General health usual sign of illness or drug side effect
15 Diagnosis Entirely clinical! There is no objective test. Determine the timeline of the mental status changes Are they fluctuating? What is the level of consciousness? What is the ability to pay attention?
16 Multifactorial Risk Assessment Predisposing Factors Age Dementia Stroke Parkinson s Disease Multiple Co-morbidities Impaired Vision Impaired Hearing Functional Impairment (ADL) Males Alcohol abuse Precipitating Factors New acute medical problem Exacerbation of chronic medical Surgery and/or anesthesia New psychoactive medication Acute stroke Pain Change in environment Urinary retention Constipation/Impaction Dehydration Sepsis/Infection
17 Mnemonic for Precipitating Factors Drugs Electrolyte imbalance Lack of drugs Infection Reduced sensory input Intracranial Urinary or fecal problems Myocardial (heart) and lungs medications, recently started or stopped, changes in dosages, over-the-counter medications, herbals, alcohol especially from dehydration stopping medications, alcohol withdrawal urinary or respiratory tract infections; blood or wound infection after an injury or surgery poor or uncorrected vision and hearing stroke inability to empty bladder or bowel heart attack, pneumonia, or other condition causing lack of oxygen in the blood and the brain
18
19 Scales Delirium Observation Screening Scale (DOSS) Delirium Rating Scale (DRS) Delirium Rating Scale-Revised-98 (DRS-R-98) Digit Span Test Global Attentiveness Rating (GAR) Memorial Delirium Assessment Scale (MDAS) Mini-Mental State Examination (MMSE) Nursing Delirium Screening Scale (Nu-DESC) Vigilance A Test
20 Confusion Assessment Method (CAM) The copyright of the CAM is owned by Sharon K. Inouye, Yale University School of Medicine. A training manual and permission to use the CAM are available online at /TheConfusionAssessmentMethod.pdf
21 Tests for Attention Squeeze or raise hand when they hear a letter in a list: G D H A U A I W P A Spell WORLD backwards Recite serial 7 s or 3 s Show pictures or objects and ask for recall in one minute Days of the week (or months) backwards Digit span - up to 5 forwards and 4 backwards
22
23
24 Labs and Imaging Tailored to history and exam Electrolytes CBC if anemia is considered LFT s, ammonia if hepatic encephalopathy is considered ABG for hypercarbia Toxicology screen and drug levels Cultures and UA CXR MRI Brain EEG Lumbar Puncture
25 Prevention and Management of Delirium in the Older Hospitalized Patient. Inouye SK. N Engl J Med 2006;354:
26
27 Delirium Management Make diagnosis Support/educate patient and family Non pharmacologic interventions Establish goals (need prognosis) Consider work up/treatment of potentially correctible etiologies Aggressively treat distressing symptoms
28 Non-pharmacologic Interventions Cognitive Orientation (calendar, caregiver names) Activities (cognitively stimulating) Sleep Regular routine Sleep aids (relaxing music, massage) Environmental (eliminate noise, night time meds) Mobility (range of motion, limit IV s, etc) Visual Aids (glasses, large dial phones, etc) Hearing Aids (check ear wax) Volume repletion for dehydration (beverage of choice available and offered frequently)
29 Pharmacologic Treatments No medication is FDA approved for the treatment of delirium No published double blind, randomized, placebo controlled trials Few controlled trials Small numbers Various patient populations post op, ICU, cancer, AIDS, hip fractures
30 Haldol vs. Benzodiazapenes Double blind RCT 244 AIDS patients 30 (12%) patients developed delirium Haloperidol (n =11) Chlorpromazine (n = 13) Lorazepam (n = 6) Haloperidol equivalent to chlorpromazine > lorazepam
31 Inouye SK. N Engl J Med 2006;354:
32 Antipsychotics Typicals (haloperidol, chlorpromazine) have greatest evidence base, are cheaper, and have multiple routes of administration
33 Antipsychotics & Black Box Mortality increased in dementia with antipsychotics Black Box Warning Issued in 2004 Consistent across all antipsychotics Relative risk = Absolute risk = 3.5% vs. 2.3% with placebo Number Needed to Harm = 83 Number need to treat = 5 14 For every 9 25 persons helped, 1 death associated with use Delirium No evidence that mortality is increased Not examined closely
34 Prevention Prospective matched trial of usual care vs ELP (Elder Life Program) in 852 enrolled patients Inouye SK. A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients. N Engl J Med. N Engl J Med 1999; 340: Geriatric Consult Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001;49: Antipsychotics Kalisvaart KJ, de Jonghe JF, Bogaards et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc. 2005;53:
35 Risk Factors for Delirium and Intervention Protocols. Inouye SK et al. N Engl J Med 1999;340:
36 Cumulative Incidence of Delirium According to Study Group. Inouye SK et al. N Engl J Med 1999;340:
37 Prevention ELP intervention The cost of intervention per case of delirium prevented was $6,341 No difference in LOS or mortality HELP (Hospital Elder Life Program)
38 Prevention Geriatric Consult Geriatric Consultation 126 patients aged 65 and older admitted emergently with hip fracture Randomized trial of Usual care vs Geriatric consults Average of 10 (!) recommendations with 77% compliance Delirium in consult group reduced by over 1/3 Severe delirium in consult group reduced by over 1/2
39 Prevention - Medication High risk patients with hip fractures received haloperidol 0.5mg three times daily Reduced severity and duration of delirium but not incidence All three approaches were preventative
40 Delirium at end of life Up to 85% At end of life, etiology varies 42% dehydration 29% liver failure 25% medication Why treat? QOL Time for patient and family Can help 50% of the time Constipation, Retention Adjust medications Hydrate as per family and patient wishes
41 Guidelines and Resources PIER from ACP American Psychiatric Association National Institute for Excellence (NICE) Vanderbilt University ICU (Pocket cards can be downloaded here)
42 Patient and Family information
43 Selected References Marcantonio ER. In the clinic. Delirium. Ann Intern Med Jun 7;154(11):ITC6-16. Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Database Syst Rev. 2007:CD Inouye SK. Delirium in older persons. N Engl J Med. 2006;354:
Delirium. Dr. John Puxty
Delirium Dr. John Puxty Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors, causes and main
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2015 Mamata Yanamadala M.B.B.S, MS Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2017 Liza Genao, MD Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity Very much under-recognized
More informationDelirium in Hospital Care
Delirium in Hospital Care Dr John Puxty 1 Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors,
More informationUpdate - Delirium in Elders
Update - Delirium in Elders Impact Recognition Prevention, and Management Michael J. Lichtenstein, MD F. Carter Pannill, Jr. Professor of Medicine Chief, Division of Geriatrics, Gerontology and Palliative
More informationDelirium Pilot Project
CCU Nurses: Delirium Pilot Project Our unit has been selected to develop and implement a delirium assessment and intervention program. We are beginning Phase 1 with education and assessing for our baseline
More informationDelirium Assessment. February 24, Susan Schumacher, MS, APRN-BC
Delirium Assessment February 24, 2016 Susan Schumacher, MS, APRN-BC Objectives Define delirium Differentiate delirium from dementia Identify predisposing and precipitating factors leading to delirium.
More informationDelirium. A Geriatric Syndrome. Jonathan McCaleb, MD, CMD, HMDC UNSOM, Assistant Professor of Medicine Geriatrics / Hospice & Palliative Medicine
Delirium A Geriatric Syndrome Jonathan McCaleb, MD, CMD, HMDC UNSOM, Assistant Professor of Medicine Geriatrics / Hospice & Palliative Medicine Introduction Common Serious Unrecognized: a medical emergency
More informationDelirium. Quick reference guide. Issue date: July Diagnosis, prevention and management
Issue date: July 2010 Delirium Diagnosis, prevention and management Developed by the National Clinical Guideline Centre for Acute and Chronic Conditions About this booklet This is a quick reference guide
More informationSummary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
More informationDelirium in Older Persons
Objectives Delirium in Older Persons ELITE 2018 Liza Isabel Genao, MD Division of Geriatrics Describe rate, cost, complications of delirium Effectively diagnose the syndrome Describe multicomponent model
More informationDelirium. Delirium. Delirium Etiology and Pathophysiology. Fall 2018
Three most common cognitive problems in adults 1. (acute confusion) 2. Dementia 3. Depression These problems often occur together Can you think of common stimuli for each? 1 1 State of temporary but acute
More informationDelirium in the hospitalized patient
Delirium in the hospitalized patient Jennifer A. Tarin, M.D. Department of Hospital Medicine Geriatric Health Safety Chair Colorado Permanente Medical Group UCLA Reynolds Scholar Delirium Preventing delirium
More informationHow to prevent delirium in nursing home. Dr. Sophie ALLEPAERTS Geriatric department CHU-Liège Belgium
How to prevent delirium in nursing home Dr. Sophie ALLEPAERTS Geriatric department CHU-Liège Belgium 1 CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report 2 Outline 1. Introduction
More informationLearning Objectives. Delirium. Delirium. Delirium. Terminal Restlessness 3/28/2016
Terminal Restlessness Dr. Christopher Churchill St. Cloud VA Health Care System EC&R Service Line Director & Medical Director Hospice & Palliative Care March 31, 2016 Learning Objectives Different Terminology
More informationDelirium and cognitive impairment in the perioperative
Delirium and cognitive impairment in the perioperative period Richard Sztramko Assistant Professor, McMaster University Divisions of Geriatrics and General Internal Medicine Disclosures Chief Medical Officer
More information5 older patients become delirious every minute
Management of Delirium: Nonpharmacologic and Pharmacologic Approaches Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley
More informationThe Agitated. Older Patient: old. What To Do? Michelle Gibson, MD, CCFP Presented at Brockville General Hospital Rounds, May 2003
Focus on CME at Queen s University Focus on CME at Queen s University The Agitated The Older Patient: What To Do? Michelle Gibson, MD, CCFP Presented at Brockville General Hospital Rounds, May 2003 Both
More informationDelirium. Approach. Symptom Update Masterclass:
Symptom Update Masterclass: Delirium Jason Boland Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine Wolfson Centre for Palliative Care Research Hull York Medical School University
More informationConfusion in the acute setting Dr Susan Shenkin
Confusion in the acute setting Dr Susan Shenkin Susan.Shenkin@ed.ac.uk 4 th International Conference, Society for Acute Medicine, Edinburgh 7-8 October 2010 Summary Confusion is not a diagnosis Main differentials
More informationDelirium in the ICU: Prevention and Treatment. Delirium Defined Officially. Delirium: Really Defined. S. Andrew Josephson, MD
Delirium in the ICU: Prevention and Treatment S. Andrew Josephson, MD Director, Neurohospitalist Service Medical Director, Inpatient Neurology June 2, 2011 Delirium Defined Officially (DSM-IV-TR) criteria
More informationDelirium and Dementia. Summary
Delirium and Dementia Paul Kettl, M.D., M.H.A. Summary DELIRIUM Acute brain failure Identify cause (meds, infection) Treat sx Poor prognostic sign DEMENTIA Chronic brain failure AD most common cause Often
More informationDelirium. Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta
Delirium Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta Overview A. Delirium - the nature of the beast B. Significance of delirium C. An approach
More informationA Neurologist s Approach to Altered Mental Status
A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 23, 2008 The speaker has no disclosures Case 1 A 71 year-old
More informationDelirium. Assessment and Management
Delirium Assessment and Management Goals and Objectives Participants will: 1. be able to recognize and diagnose the syndrome of delirium. 2. understand the causes of delirium. 3. become knowledgeable about
More informationDo you know. Assessment of Delirium. What is Delirium? Which syndrome occurs more commonly in elderly populations? a. Delirium b.
Assessment of Delirium Marianne McCarthy, PhD, GNP, PMHNP Arizona State University College of Nursing and Health Innovation What is Delirium? Delirium is a common clinical syndrome characterized by: Inattention
More informationDELIRIUM DR S A R A H A B D E L A T I S A S DR H I L A R Y W O L F E N D A L E S T 4
DELIRIUM DR S A R A H A B D E L A T I S A S DR H I L A R Y W O L F E N D A L E S T 4 AIMS Define delirium Identify: Different types of delirium Risk factors Preventable causes Screening tools Management
More informationDelirium in the Emergency Department. Emergency Medicine Rounds April 14, 2015 Paul R. Vanhoutte
Delirium in the Emergency Department Emergency Medicine Rounds April 14, 2015 Paul R. Vanhoutte Goals of Rounds: Review Definition Management An Understanding What is important is to spread confusion,
More informationJacinta Lucke Resident Emergency Medicine PHD Gerontology & Geriatrics
Jacinta Lucke Resident Emergency Medicine PHD Gerontology & Geriatrics TAKE HOME MESSAGE When managing confusion in older patients: Routinely screen for impaired cognition Patients with impaired cognition
More informationObjectives. Delirium in the Elderly Patient. Disclosure. Arizona Geriatrics Society Fall Symposium 2010
Delirium in the Elderly Patient Sandra Jacobson, MD Banner Sun Health Research Institute Arizona Geriatrics Society Fall Symposium 2010 Disclosure Dr. Jacobson has disclosed that she does not have any
More informationDelirium in Older Persons: An Investigative Journey
Delirium in Older Persons: An Investigative Journey Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy Family Chair
More informationStrategies to minimize delirium for hip fracture patients
Strategies to minimize delirium for hip fracture patients Stephen L Kates, M.D. Professor and Chairman Department Date of Orthopaedic Surgery Delirium incidence Up to 61% of hip fracture patients get delirium
More informationDelirium. A Plan to Reduce Use of Restraints. David Wensel DO, FAAHPM Medical Director Midland Care
Delirium A Plan to Reduce Use of Restraints David Wensel DO, FAAHPM Medical Director Midland Care Objectives Define delirium Describe pathophysiology of delirium Understand most common etiologies Define
More information5 older patients become. What is delirium? (Acute confusional state) Where We ve Been and
Update on Delirium: Where We ve Been and Where We re Going Sharon K. Inouye, M.D., M.P.H. M PH Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy
More information譫妄症 (Delirium) Objectives. Epidemiology. Delirium. DSM-5 Diagnostic Criteria. Prognosis 台大醫院老年醫學部陳人豪 2016/8/28
譫妄症 (Delirium) 台大醫院老年醫學部陳人豪 2016/8/28 Objectives Delirium Epidemiology Etiology Diagnosis Evaluation and Management Postoperative delirium Delirium (and acute problematic behavior) in the longterm care
More informationCase 1. Delirium and a Neurologist s Approach to AMS in the Hospital Setting. (DSM-IV-TR) criteria for delirium 11/6/2010
Delirium and a Neurologist s Approach to AMS in the Hospital Setting S. Andrew Josephson, MD Director, Neurohospitalist Program Medical Director, Inpatient Neurology University of California San Francisco
More informationChapter 01 Introduction
Chapter 01 Introduction Defining the Elderly There is no universally accepted age cut-off defining elderly. This reflects the fact that chronological age itself is less important than biological events
More informationPreventing Delirium among Older Adults with Dementia
Preventing Delirium among Older Adults with Donna M. Fick, PhD, GCNS-BC, Associate Professor of Nursing, School of Nursing, Pennsylvania State University, University Park, PA, USA. Ann Kolanowski, PhD,
More informationDelirium Prevention: The State-of-the-Art & Implications to Improve Care in our State
Delirium Prevention: The State-of-the-Art & Implications to Improve Care in our State Jonny Macias, MD & Michael Malone, MD Aurora Health Care/ University of Wisconsin School of Medicine & Public Health
More informationDelirium in the Elderly
Delirium in the Elderly Jeffrey M. Burock, MD Division Director/ Psychiatry / Miriam Hospital Clinical Assistant Professor Warren Alpert School Of Medicine Learning Objectives Identify the symptoms of
More informationDelirium. Dr. Lesley Wiesenfeld. Deputy Psychiatrist in Chief, Mount Sinai Hospital. Dr. Carole Cohen
Delirium Dr. Lesley Wiesenfeld Deputy Psychiatrist in Chief, Mount Sinai Hospital Dr. Carole Cohen Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre Case Study Mrs B
More informationImproving the quality of care of patients with delirium
Improving the quality of care of patients with delirium Alasdair MacLullich MRCP(UK), PhD Professor of Geriatric Medicine University of Edinburgh Scotland How are we doing now? We are doing badly. Difficult
More informationDelirium Assessment and the assessment of people at risk
Assessment and the assessment of people at risk Tracey Mc Erlain Burns RGN, Dip N (lond), MBA, Chief Nurse The Rotherham NHS Foundation Trust What is delirium? Historically seen as a person who is confused/
More informationDelirium: A Condition of All Ages. Delirium, also known as acute confusional state, Definition. Epidemiology
Focus on CME at the University of Calgary : A Condition of All Ages While delirium can strike at any age, physicians need to be particularly watchful for it in elderly patients, so that a search for the
More informationDelirium. Delirium is characterized by an acute onset (hours or days) and fluctuating course of deterioration in mental functioning.
Delirium Delirium is characterized by an acute onset (hours or days) and fluctuating course of deterioration in mental functioning. DELIRIUM IS A MEDICAL EMERGENCY! Delirium: Hallmark Features Inattention-
More informationDelirium and Dementia
Delirium and Dementia Elder Friendly Care in Acute Care Seniors Health Strategic Clinical Network Acute Care Stress Blender Poor Poor sleep At-Risk Older Adult TREAT CAUSE immediately & aggressively. Increased
More informationDelirium Assessment and management in relation to falls risk in hospital
Delirium Assessment and management in relation to falls risk in hospital A house call - Mrs JM 95-year-old lady Normally cognitively intact Multiple medical problems, including falls Housebound, mobile
More informationDelirium assessment and management. Dr Kim Jeffs Northern Health
Delirium assessment and management Dr Kim Jeffs Northern Health What do you need to know? Epidemiology How big is the problem? Who is at risk? Assessment Tools for diagnosis Prevention Evidence base Management
More informationH.E.L.P. ing Elder Trauma Patients Avoid Delirium and Functional Decline
H.E.L.P. ing Elder Trauma Patients Avoid Delirium and Functional Decline Montreal ITC 2014 Sept. 26 Joann Creager, CNS Geriatrics, Manager, MUHC Elder Friendly Hospital Presentation Overview 1. Elder patient
More informationg Prevention, Diagnosis, and Management in Palliative Care
8/3/2012 Improving p g Prevention, Diagnosis, g and Management in Palliative Care MN Rural Palliative Care Networking Group Quarterly Education Session June 27,2012 Sandra W. Gordon-Kolb, MD, MMM, CPE
More informationDelirium, Depression and Dementia
Delirium, Depression and Dementia Martha Watson, MS, APRN, GCNS Some material included in this presentation is adapted from: NICHE (2009). Geriatric Resource Nurse Core Curriculum [Power Point presentation].
More informationWhy Target Delirium for Surgical Quality Improvement?
Why Target Delirium for Surgical Quality Improvement? Tom Robinson MD FACS thomas.robinson@ucdenver.edu July 22, 2018 Disclosures Tom Robinson has no disclosures. Who Cares About the Brain? Acute Organ
More informationDIAH MUSTIKA HW SpS,KIC Intensive Care Unit of Emergency Department Naval Hospital dr RAMELAN, Surabaya
DIAH MUSTIKA HW SpS,KIC Intensive Care Unit of Emergency Department Naval Hospital dr RAMELAN, Surabaya Encephalopathy is a common complication of systemic illness or direct brain injury. Acute confusional
More informationManagement of delirium in mechanically ventilated patients. Advances in Critical Care Medicine King Hussein Cancer Center
Management of delirium in mechanically ventilated patients Advances in Critical Care Medicine King Hussein Cancer Center Introduction Outline: Prevalence of delirium in ICU Why it is important to screen
More informationPalliative Care and Delirium. Ambereen K. Mehta, MD MPH Assistant Professor Division of General Medicine, Geriatrics, and Palliative Care
Palliative Care and Delirium Ambereen K. Mehta, MD MPH Assistant Professor Division of General Medicine, Geriatrics, and Palliative Care Disclosures I have no personal or professional financial relationships
More informationDelirium: developing and implementing a multi-component intervention
Delirium: developing and implementing a multi-component intervention Dr. Duncan Forsyth Consultant Geriatrician Addenbrooke s Hospital Cambridge University Hospitals NHS Foundation Trust Cambridge, England
More informationDELIRIUM. Approach and Management
DELIRIUM Approach and Management By Dr. K.S. Jacob, Professor of Psychiatry and Dr. Anju Kuruvilla, Professor of Psychiatry, Christian Medical College, Vellore. Based on a chapter in the book Psychiatric
More informationDecreasing Delirium Resolution Times for the Elderly: An Interprofessional Approach
Decreasing Delirium Resolution Times for the Elderly: An Interprofessional Approach Featuring: Felice Rogers Evans BSN RN BC Ty Breiter MSN RN CNL Tampa General Hospital NICHE exemplar hospital Three time
More informationDelirium Undetected: The impact of allied health care professional documentation on delirium detection in hospitalized elders
Delirium Undetected: The impact of allied health care professional documentation on delirium detection in hospitalized elders Sheryl Hodgson Canadian Geriatrics Society April 20, 2018 Disclosure Presenter:
More informationCare of Patient with Delirium
Care of Patient with Delirium Introduction Delirium is an alteration in consciousness involving confusion and other changes in cognitive ability that has a brief duration. 1 Patients specifically at risk
More informationCognitive Status. Read each question below to the patient. Score one point for each correct response.
Diagnosis of dementia or delirium Cognitive Status Six Item Screener Read to the patient: I have a few questions I would like to ask you. First, I am going to name three objects. After I have said all
More informationThe Person: Dementia Basics
The Person: Dementia Basics Objectives 1. Discuss how expected age related changes in the brain might affect an individual's cognition and functioning 2. Discuss how changes in the brain due to Alzheimer
More informationGeriatrics and Cancer Care
Geriatrics and Cancer Care Roger Wong, BMSc, MD, FRCPC, FACP Postgraduate Dean of Medical Education Clinical Professor, Division of Geriatric Medicine UBC Faculty of Medicine Disclosure No competing interests
More informationDELIRIUM. J. Sukanya 28.Jun.12
DELIRIUM J. Sukanya 28.Jun.12 Outline Why? What? How? What s next? Delirium Introduction Delirium An acute decline in attention and cognition The most frequent neuropsychiatric syndrome A common, life-threatening,
More informationDelirium Screening: The next nurse sensitive indicator?
Delirium Screening: The next nurse sensitive indicator? Sharon Gunn, MSN, MA, RN, ACNS-BC, CCRN Clinical Nurse Specialist Critical Care Baylor University Medical Center Dallas, TX Objectives Recognize
More informationDelirium Information for patients and relatives. Delirium is common Delirium is treatable Relatives can stay to help us
Delirium Information for patients and relatives Delirium is common Delirium is treatable Relatives can stay to help us What is delirium? Delirium is caused by a disturbance of brain function. It is used
More informationBRAIN. Tumor byproducts. Autonomic nerves. Somatic nerves. Host immune cells. Cytokines
Patient s Problems Pain (80%) Fatigue (90%) Weight Loss (80%) Lack of Appetite (80%) Nausea, Vomiting (90%) Anxiety (25%) Shortness of Breath (50%) Confusion-Agitation (80%) Tumor Mass Tumor Function Somatic
More informationPerioperative Care of Older Adults
Perioperative Care of Older Adults SARAH A. WINGFIELD, MD AND THOMAS O. DALTON, MD UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER DIVISION OF GERIATRIC MEDICINE We have no disclosures. Objectives -Recognize
More informationPerioperative Care of Older Adults
Perioperative Care of Older Adults SARAH A. WINGFIELD, MD AND THOMAS O. DALTON, MD UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER DIVISION OF GERIATRIC MEDICINE We have no disclosures. Objectives -Recognize
More informationGeriatric Alterations Associated with Neurological Conditions
Geriatric Alterations Associated with Neurological Conditions I have no conflicts of interest. Julie Bronson The Older Adult According to the World Health Organization Africa 50-55 or 50-65 United Nations
More informationOhio/Minnesota Collaborative
Ohio/Minnesota Collaborative Place picture here Delirium Prevention Virtual Learning Session February 24, 2016 Delirium collaboration Ohio and Minnesota HENs In December 2015, the Minnesota and Ohio HENS
More informationNorthumbria Healthcare NHS Foundation Trust. Your guide to understanding Delirium. Issued by Department of Medicine
Northumbria Healthcare NHS Foundation Trust Your guide to understanding Delirium Issued by Department of Medicine Purpose of this leaflet This leaflet is for patients and carers and aims to give you information
More informationThe Long-term Prognosis of Delirium
The Long-term Prognosis of Jane McCusker, MD, DrPH, Professor, Epidemiology and Biostatistics, McGill University; Head, Clinical Epidemiology and Community Studies, St. Mary s Hospital, Montreal, QC. Nine
More informationDementia and Delirium: A Neurologist s Approach to Altered Mental Status. Case 1 4/7/11. Which of the following evaluations is your next step?
Dementia and Delirium: A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Director, Neurohospitalist Program Medical Director, Inpatient Neurology University of California San Francisco
More informationGeriatric Grand Rounds
Geriatric Grand Rounds Prevalence and Risk Factors of Delirium in Older Patients Admitted to a Community Based Acute Care Hospital Tuesday, October 27, 2009 12:00 noon Dr. Bill Black Auditorium Glenrose
More informationTest your Knowledge: Recognizing Delirium
The Ottawa Hospital Name: Unit: Profession: RN RPN PT OT SW Other Note: Each question has only one correct answer. 1. If a patient is identified as being at high risk for developing delirium, his/her mental
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationDelirium in Palliative care. Presentation to Volunteers 2016 David Falk
Delirium in Palliative care Presentation to Volunteers 2016 David Falk Delirium What is delirium? Case Study - Delirium 60+ year old PQ presents to hospice very somnolent. She was admitted with her adult
More informationCauses of Transient Incontinence. Geriatrics: Urinary Incontinence, Dementia, and Delirium. Classification of Established Incontinence
Causes of Transient Geriatrics: Urinary, Dementia, and Delirium Carla Zeilmann, PharmD, BCPS St. Louis College of Pharmacy Therapeutics 3 Fall 2003 D delirium I infection A atrophic urethritis and vaginitis
More informationDisclosures No financial conflicts of interest. Key Questions
Hospital Delirium: New Evidence in Diagnosis & Treatment Ethan Cumbler MD, FHM, FACP Professor of Medicine Medical Director Acute Care For Elderly Unit University of Colorado School of Medicine Disclosures
More informationFalls Prevention Best Practice
Falls Prevention Best Practice Prepared by Denise Tomassini Falls Prevention A case study : Mr Tony Topples ISLHD Clinical Quality Manager Clinical Governance Unit November 2011 Falls Prevention Best Practice
More informationHome Care and Hospice Association of New Jersey Annual Conference 2017
Home Care and Hospice Association of New Jersey Annual Conference 2017 I D E N T I F I C A T I O N A N D M A N A G E M E N T O F D E L I R I U M E L I Z A B E T H M A G E R - O C O N N O R A C H P N DR
More informationDrug induced delirium
Drug induced delirium Knut Erik Hovda, MD, PhD, FACMT, FEAPCCT The Norwegian CBRNe Centre of Medicine Department of Acute Medicine Oslo University hospital Content 1. Introduction 2. Risk factors 3. Prevalence
More informationDavid A Scott Lis Evered. Department of Anaesthesia and Acute Pain Medicine St Vincent s Hospital, Melbourne University of Melbourne
David A Scott Lis Evered Department of Anaesthesia and Acute Pain Medicine St Vincent s Hospital, Melbourne University of Melbourne This talk will include live polling so please be sure to have the meeting
More informationEMS Subspecialty Certification Review Course. Learning Objectives. Geriatric Patients and EMS Systems
EMS Subspecialty Certification Review Course Challenges in Geriatric Patient Care 1.4.6 Geriatric Issues Version: 2017 Learning Objectives Upon the completion of this program participants will be able
More informationMouth care for people with dementia. Delirium (Confusion) Understanding changes in behaviour in dementia
Mouth care for people with dementia Delirium (Confusion) Understanding changes in behaviour in dementia 2 Dementia UK Delirium (confusion) A sudden change in a person s mental state is known as delirium.
More informationThe triad of inpatient harm
Delirium in hospital: Identification, prevention and management Dr Jonathan Treml Consultant Geriatrician Queen Elizabeth Hospital Birmingham, UK With thanks to Dr Thomas Jackson for some of the slides
More informationDelirium. Patient Information Leaflet
Delirium Patient Information Leaflet Betty, a lady who had been admitted to hospital with a broken hip, had been fully independent in her own home. A few days after surgery to repair her hip she became
More informationDisclosures. Post operative Delirium. Set up audience participation. Delirium Definitions. Incidence of Delirium
Post operative Delirium Disclosures IP for monitoring technology licensed to Medtronic Ken Brady, MD Pediatrics, Anesthesia, Critical Care Texas Children s Hospital Baylor College of Medicine Set up audience
More informationCritical Care Pharmacological Management of Delirium
Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care
More informationDisentangling Delirium and Dementia
Disentangling Delirium and Dementia Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy Family Chair Director, Aging
More informationThere s No Place like Home
THERE S NO PLACE LIKE HOME There s No Place like Home Regional Advisory Committee for Excellence in Care of Older Adults Elements of the Program TAKE AWAY SERVICES R & G PROGRAM CONSULTATION O SERVICES
More informationCognitive disorders. Dr S. Mashaphu Department of Psychiatry
Cognitive disorders Dr S. Mashaphu Department of Psychiatry Delirium Syndrome characterised by: Disturbance of consciousness Impaired attention Change in cognition Develops over hours-days Fluctuates during
More informationCharles Bernick, MD, MPH Cleveland Clinic Lou Ruvo Center for Brain Health June 2, 2018
Charles Bernick, MD, MPH Cleveland Clinic Lou Ruvo Center for Brain Health June 2, 2018 Delirium common Prolongs hospitalization Worsens dementia ( if you survive) Increased risk of institutionalization
More informationHow to prevent delirium in the Emergency Room. Nice September 21, 2017 Steffen Schlee/ Katrin Singer
How to prevent delirium in the Emergency Room Nice September 21, 2017 Steffen Schlee/ Katrin Singer CONFLICT OF INTEREST DISCLOSURE K. Singler and St. Schlee have no potential conflict of interest to report.
More informationStrategies to Recognize & B.E.A.T. Delirium. Amy E. Seitz Cooley, MS, RN, ACNS-BC Clinical Nurse Specialist York College of Pennsylvania DNP Student
Strategies to Recognize & B.E.A.T. Delirium Amy E. Seitz Cooley, MS, RN, ACNS-BC Clinical Nurse Specialist York College of Pennsylvania DNP Student The very first requirement in a hospital is that it should
More informationAddressing Difficult Behaviors in Dementia
Addressing Difficult Behaviors in Dementia GEORGE SCHOEPHOERSTER, MD GERIATRICIAN GENEVIVE/CENTRACARE CLINIC Objectives By the end of the session, you will be able to: 1) Explain the role of pain management
More informationFrequently Asked Questions About Dementia
Frequently Asked Questions About Dementia Disclaimer This is general information developed by The Ottawa Hospital. It is not intended to replace the advice of a qualified healthcare provider. Please consult
More informationDelirium. Steve Ellen
Delirium Steve Ellen MB, BS. M.Med. MD. FRANZCP Head, Consultation, Liaison & Emergency Psychiatry, Alfred Health. Associate Professor, Monash Alfred Psychiatry Research Centre, Central Clinical School,
More informationEvaluating Functional Status in Hospitalized Geriatric Patients. UCLA-Santa Monica Geriatric Medicine Didactic Lecture Series
Evaluating Functional Status in Hospitalized Geriatric Patients UCLA-Santa Monica Geriatric Medicine Didactic Lecture Series Case 88 y.o. woman was admitted for a fall onto her hip. She is having trouble
More information