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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Delirium in elderly people.

Sharon K Inouye¹, Rudi G J Westendorp², Jane S Saczynski³

¹Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.

Lancet (London, England)

|September 3, 2013

Summary

Delirium, a common and serious acute cognitive disorder in older adults, requires formal diagnosis. Non-pharmacological prevention is most effective, as drug treatments lack evidence.

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Area of Science:

Geriatrics
Neurology
Public Health

Background:

Delirium is a frequent, severe, and often fatal acute disorder affecting attention and cognition in individuals aged 65 and older.
It is under-recognized despite significant costs and mortality.
Diagnosis relies on formal cognitive assessment and a history of acute symptom onset.

Purpose of the Study:

To review the current understanding of delirium in the elderly.
To highlight effective prevention and treatment strategies.
To emphasize delirium's role in understanding brain pathophysiology and patient safety.

Main Methods:

Review of existing literature on delirium diagnosis, prevention, and treatment.
Analysis of delirium's implications for brain health and patient safety.
Discussion of public health priorities related to delirium.

Main Results:

Multicomponent, non-pharmacological approaches are the most effective strategy for delirium prevention.
There is no convincing evidence supporting the efficacy of pharmacological prevention or treatment.
Drug reduction for sedation and analgesia, alongside non-pharmacological methods, is recommended.

Conclusions:

Delirium serves as a marker of brain vulnerability and a potential mechanism for cognitive damage.
Addressing delirium is crucial for improving patient safety and driving system-wide process improvements.
Public health efforts should focus on improved coding, reimbursement, research funding, and education for clinicians and the public.