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Psychological Medicine
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Harrison Howarth, Jim Bolton, Gary Bell
Investigations should be carried out to identify the underlying cause of the delirium, including blood tests, urine analysis, and imaging scans if appropriate (chest X-ray, CT head).
Delirium
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Ronny Munoz-Acuna, Brian O'Gara
The treatment of established delirium should be twofold: first to manage the behavioral disturbance, and secondly to find and treat the underlying medical disorder. Unfortunately, the non-pharmacological interventions mentioned above are less effective if implemented once delirium has occurred. Evidence supporting the use of pharmacologic agents for delirium treatment is inconclusive. Haloperidol remains the standard therapy in this setting. However, newer atypical antipsychotic agents such as quetiapine, risperidone, ziprasidone, and olanzapine have fewer side effects with similar efficacy, but their use has not been shown to prevent delirium in clinical trials. Given that extrapyramidal and cardiovascular complications are common side effects of both typical and atypical antipsychotics, dexmedetomidine has come to the forefront of delirium treatment in the ICU. The DahLIa study randomized patients to dexmedetomidine versus placebo, showing a hastened time to resolution of delirium in the dexmedetomidine group (median[IQR] 23.3 [13.0–54.0] vs. 40.0 [25.3–76.0] h, p = 0.01) and significantly fewer patients treated with antipsychotics(65.6% vs. 36.8%, 95% CI, 51.3–6.3%, p = 0.02) in the treatment group. Benzodiazepines are currently avoided as they may increase delirium incidence [10].
Dementia and physical health
Published in Graham A. Jackson, Debbie Tolson, Textbook of Dementia Care, 2019
Individuals who are physically unwell and have dementia are at increased risk of delirium. This risk is significantly higher than in the general population without dementia. Delirium can accentuate the long term cognitive state of the patient.
Prioritizing geriatrics in medical education improves care for all
Published in Medical Education Online, 2022
Samuel Rentsch, Caroline A. Vitale, Kahli Zietlow
Although unintentional, the lack of targeted geriatric education and training among residency programs further exacerbates institutions’ inability to provide adequate care of this often-vulnerable population. Delirium and dementia are under-recognized, and risk being written off as normal aging. Sensory impairments preventing adequate communication are overlooked. Social factors, such as isolation, food insecurity, and lack of reliable internet access, often go unrecognized or worse, are disregarded. The under-recognition of geriatric syndromes and social determinants of health among older adults is associated with poorer quality of life, increased functional and cognitive impairment, medication non-adherence, poorer survival, increased healthcare utilization, and substantial costs to healthcare systems[19].
From fear to fight: Patients experiences of early mobilization in intensive care. A qualitative interview study
Published in Physiotherapy Theory and Practice, 2022
Annika Söderberg, Veronika Karlsson, Beth Maina Ahlberg, Anita Johansson, Annelie Thelandersson
In the fight for independence, several participants commented that they had not been depressed, and that it was important not to become discouraged or downhearted. Hopkins, Suchyta, Farrer, and Needham (2012) found that physical activity helped to reduce anxiety and depression. EM may have the same effect, since EM can at times involves not only moderate, but also more strenuous physical activity. The relationship between body and mind can also be seen in the RCT-study by Schweickert et al. (2009) which showed a significant correlation between EM and the number of days with delirium in the ICU. Delirium is also an independent predictor of mortality (Schweickert et al., 2009) and duration of delirium is independently associated with long-term cognitive impairments (Hopkins, Suchyta, Farrer, and Needham, 2012).
An Oncology Nurse Residency Program Improves Knowledge of Delirium in Older Patients with Cancer
Published in Oncology Issues, 2021
Cassandra Vonnes, Janelle Brown, Joellen Warnke, Tina Mason
Moffitt developed an inter-professional simulated case study of standardized patients, which required the participation of a primary nurse, provider, respiratory therapist, and a standardized patient who was played by a patient advisor. Before participating, patient volunteers trained in patient- and family-centered care with the goal of compassionate care. This delirium simulation is an enhanced learning scenario and was introduced to oncology nurse residents after a geriatric clinical specialist provided a didactic presentation in which learning objectives ask participants to:23Identify presentations of the subtypes of delirium.Review risk factors for the development of delirium in the older adult with cancer.Apply interventions to reduce the onset of delirium.Describe the initial workup of delirium in a hospitalized patient.Use the Confusion Assessment Method for screening of suspected delirium.