Prevention of delirium in the elderly

The incidence of delirium in the elderly in general hospitals is up to 20 to 65%. Delirium is associated with high mortality, increased morbidity, increased need for nursing surveillance, longer hospital stays and a high rate of institutionalization following discharge. Delirium is not recognized by clinicians in one- to two-thirds of all cases and is commonly overlooked or misattributed to dementia, depression, or senescence; confusional states in the hospitalized elderly are considered the rule, rather than the exception and cognitive function is rarely assessed. For prevention of delirium it is necessary to look for patients "at-risk" for delirium and to use instruments for screenings and severity. Also should the medical and nursing staff be made aware of prodromal symptoms for delirium, indicating a delirium is developing. Prevention requires multidisciplinary action with pharmacological and non pharmacological interventions (multifactor intervention). A pro-active consultation team (doctors and nurses) resulting in good basic medical- and nursing care have the best results concerning the prevention of delirium, reducing delirium incidence with more than 25%.