Geriatric Giants
Claire Welford in Nursing & Health Survival Guide, 2014
Delirium is an acute or sudden onset of mental confusion and rapid changes in brain function as a result of medical, social and/or environmental conditions. Signs of delirium include: Changes in cognitive function, e.g. worsened concentration, slow responses, confusion.Changes in perception, e.g. visual or auditory hallucinations.Changes in physical function, e.g. reduced mobility, reduced movement, restlessness, agitation.Changes in appetite, and sleep disturbance.Changes in social behaviour, e.g. lack of cooperation with reasonable requests, withdrawal, or alterations in communication, mood and/or attitude.
Preoperative assessment and care of the elderly
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Delirium is an acute, waxing and waning change in mental status marked by deficits in attention and often complicated by agitation, lethargy or disorganized thinking. It is common in hospitalized older adults, particularly in those with underlying cognitive disorders including dementia. Delirium can be provoked by underlying medical issues (Table 3.7), which should always be sought. In the preoperative setting, uncontrolled pain should be strongly considered, particularly in patients with no other obvious cause. Initial attempts at management should include treating underlying clinical issues, optimizing pain control and attempting non-pharmacologic supports like reorientation, decreasing excessive stimulation and restoring eyeglasses and hearing aids. For severe agitation or distress, low dose haloperidol (0.5 mg IV or oral) can be administered safely in most patients. Delirium is not a contraindication to surgical fixation; fracture reduction and mobilization may be necessary to promote resolution.
Functional Assessment
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Vision is often impaired with aging due to disease processes such as age-related macular degeneration, glaucoma, diabetic retinopathy, and cataracts. The insidious progression of these diseases over the years coupled with infrequent medical evaluation obscures diagnosis of these entities until much vision is already lost. Corrective lenses’prescriptions are often not adjusted frequently enough to maximize their effectiveness. Vision impairment can reduce the patient's self-care ability, increase reliance on others for assistance, and increase caregiver burden. It is also a risk factor for incident delirium in hospitalized elderly patients (14). Simply asking the question “Do you have difficulty driving or watching television or reading or doing any of your activities because of your eyesight?” will identify at-risk patients. Follow-up evaluation with the Snellen chart for each eye can help to quantify the level of impairment (15).
Cervical spine immobilisation in the elderly: a literature review
Published in British Journal of Neurosurgery, 2018
George Edward Peck, David James Heming Shipway, Kevin Tsang, Michael Fertleman
Many elderly patients with cervical spine injuries have coexistent acute delirium, dementia and confusion associated with traumatic head injury. In a retrospective case series delirium was the second commonest complication after pneumonia in older patients with an incidence of 37.5%.43 Delirium is a well-recognised risk factor for poor outcome and in-hospital mortality in elderly patients.50 The management of delirium is challenging and requires optimisation of the patient environment including elimination of pain or discomfort, consideration of 1:1 nursing and if necessary pharmacological restraint.51 The benefit of maintaining compliance with cervical orthoses must be carefully weighed against the potential harm that comes with sedation. Close liaison between care of the elderly specialists and senior surgical decision makers is essential and the application for deprivation of liberty safeguards (DOLS) must also be considered.52
Clinical characteristics of patients admitted to emergency department for the use of ketamine analogues with or without other new psychoactive substances
Published in Clinical Toxicology, 2021
Te-I Weng, Lengsu W. Chin, Lian-Yu Chen, Ju-Yu Chen, Guan-Yuan Chen, Cheng-Chung Fang
The illicit substances detected in the urine samples, and patients’ clinical characteristics are summarized in the Table 1. The drug use pattern of our cases could be categorized as follows: only 2 F-DCK (Case 1), DCK and ketamine (Cases 2–5), and ketamine analogues with cathinones (Cases 6–13). Case 1 was a 23-year-old man with a history of recreational ketamine use. He was brought to the ED because of delirium and palpitations. He recovered consciousness 6 h later and only 2 F-DCK was detected in his urine. Cases 2–5 were patients presenting with delirium in two cases. They recovered in 6–8 h and DCK and ketamine were detected in their urine. Three patients disclosed insufflating or smoking ketamine. Cases 6-13 were patients showing delirium, agitation, and hallucination/delusion (six, three, and two cases, respectively). Tachycardia (pulse rate: >100/min), and hypertension (systolic blood pressure: >140 mmHg) in four, and three cases. Mild rhabdomyolysis was noted in two cases. All patients recovered within 1 day, and ketamine analogues and cathinones were detected in their urine. One patient confessed to ketamine insufflation; six patients reported drinking a beverage using “instant coffee packet,” which is slang for packets comprising drug mixtures sold on the Taiwanese black market.
Serious Consequences of Malnutrition and Delirium in Frail Older Patients
Published in Journal of Nutrition in Gerontology and Geriatrics, 2018
Elizabeth Rosted, Tatiana Prokofieva, Suzanne Sanders, Martin Schultz
Presence of delirium was based on a clinical assessment and characterized by the following symptoms; appearing with a sudden start and proceeding with a fluctuating course, altered attention, consciousness, orientation, memory, perception, and thoughts as well as altered behavior. Patients were only registered as demented if they had already been diagnosed with dementia by a Multidisciplinary Memory Clinic prior to admission. All other patients presenting with cognitive symptoms were registered as cognitive impairment.
Related Knowledge Centers
- Circadian Rhythm
- Delusion
- Encephalopathy
- Hallucination
- Organic Brain Syndrome
- Psychomotor Agitation
- Psychomotor Retardation
- Syndrome
- Hypoxia
- Deliriant