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Delirium in elderly people: an update
Albert F G Leentjens1, Rose C van der Mast
1Department of Psychiatry, Maastricht University Hospital, Maastricht, The Netherlands. a.leentjens@np.unimaas.nl
Current Opinion in Psychiatry
|April 28, 2006
Summary
Delirium in the elderly, while not clinically distinct from younger patients, presents diagnostic challenges, especially with dementia. Early screening and prevention are crucial, with atypical antipsychotics showing promise beyond haloperidol.
Area of Science:
- Geriatric Medicine
- Neuroscience
- Critical Care Medicine
Background:
- Delirium is a common and serious condition in elderly individuals.
- It is characterized by acute changes in attention and cognition.
- Delirium significantly impacts patient outcomes, including mortality.
Purpose of the Study:
- To review recent studies on the epidemiology, diagnosis, pathophysiology, treatment, and prevention of delirium in the elderly.
- To synthesize current knowledge on managing delirium in older adults.
Main Methods:
- Systematic review of recent literature.
- Analysis of studies on diagnostic tools, risk factors, and therapeutic interventions.
- Evaluation of evidence for screening and prevention strategies.
Main Results:
- Delirium presentation in the elderly is similar to younger populations but may have a more chronic course.
- Diagnosing delirium in patients with dementia is challenging due to overlapping symptoms.
- Predisposing factors include advanced age and cognitive dysfunction; precipitating factors include somatic events and anticholinergic drug use.
- Delirium is associated with adverse outcomes in function, cognition, morbidity, and mortality.
- Haloperidol is the standard treatment, with some evidence supporting risperidone; other atypical antipsychotics and cholinesterase inhibitors require further study.
- The effectiveness of systematic screening and standardized prevention interventions remains inconclusive.
Conclusions:
- The approach to delirium has shifted towards systematic screening and prevention.
- Research is exploring alternative treatments beyond haloperidol, including atypical antipsychotics and procholinergic drugs.