Proper clinical identification of delirium and quick use of personalized evidence-based interventions is the hallmark of treatment. Failure to identify and treat can result in increased costs but even more importantly, poor patient outcomes and subsequent decreased quality of life.
Failure to or delay in identifying delirium is common in healthcare. To compound the issue of delayed diagnosis and lack of early intervention, healthcare providers, including nurses, often contribute to the incidence of delirium by administering treatments and medications that can cause this serious condition. During the last several years there has been a notable increase in research focused on evidenced-based prevention, identification, and treatment of delirium. The bedside nurse is in a unique position to make a clinical difference for these vulnerable patients by using a systematic approach.
Delirium is a condition that can be marked by fluctuating levels of consciousness with inattention as the key feature and can be a mix of the hypoactive and hyperactive types. It is well established that delirium's adverse consequences include functional decline1, increased likelihood of falls2,3, (3) longer hospital length of stay3, (4) hospital readmissions4, (5) greater likelihood of nursing home placement1,5, (6) increased risk for subsequent development of dementia or cognitive impairment6, and (7) higher morbidity and mortality7. Evidence-based management of delirium requires an individualized, multi-component approach. An interdisciplinary approach to prevent, manage, and treat delirium is essential. This website has been created for the practitioner to be able to access high quality, evidence-based resources. It is our hope that the user will apply this information to improve the quality of care and the quality of life of those affected.
1 Dasgupta, M., & Brymer, C. (2014). Prognosis of delirium in hospitalized elderly: Worse than we thought. International Journal of Geriatric Psychiatry, 29(5), 497-505. doi: 10.1002/gps.4032.
2 Lakatos, B. E., Capasso, V., Mitchell, M. T., Kilroy, S. M., Lussier-Cushing, M., Sumner, L., Repper-Delisi, J., Kelleher, E. P., Delisle, L. A., Cruz, C., & Stern, T. A. (2009). Falls in the general hospital: Association with delirium, advanced age, and specific surgical procedures. Psychosomatics, 50(3), 218-226. doi: 10.1176/appi.psy.50.3.218.
3 Mangusan, R. F., Hooper, V., Denslow, S. A. & Travis, L. (2015). Outcomes associated with postoperative delirium after cardiac surgery. American Journal of Critical Care, 24(2), 156-163. doi: 10.4037/ajcc2015137.
4 Koster, S., Hensons, A. G. Schuurmans, M. J., & van der Palen, J. (2012). Consequences of delirium after cardiac operations. Annals of Thoracic Surgery, 93(3), 705-711. doi: 10.1016/j.athoracsur.2011.07.006.
5 Krogseth, M., Wyller, T. B., Engedal, K. & Juliebø, V. (2014). Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients. Journal of Psychosomatic Research, 76(1), 68-74. doi: 10.1016/j.jpsychores.2013.10.006.
6 Krogseth, M., Watne, L. O., Juliebø, V., Skovlund, E., Engedal, K., Frihagen, F. & Wyller, T. B. (2016). Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients. Archives of Gerontology and Geriatrics, 64, 38-44. doi: 10.1016/j.archger.2015.12.004.
7 Pauley, E., Lishmanov, A., Schumann, S., Gala, G. J., van Diepen, S. & Katz, J. N. (2015). Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit. American Heart Journal, 170(1), 79-86, 86e1. doi: 10.1016/j.ahj.2015.04.013.
Landing Page “Did You Know” Statistics References:
1 Rudolph, J. L., Archambault, E., Kelly, B. & VA Boston Delirium Task Force. (2014). A delirium risk modification program is associated with hospital outcomes. Journal of American Medical Directors Association, 15(12), 957e7-957e11.
2 Agarwal, V., O’Neil, P. J., Cotton, B. A., Pun, B. T., Haney, S., Thompson, J., Kassebaum, N., Shintani, A., Guy, J., Ely, E. W., & Pandharipande, P. (2010). Prevalence and risk factors for development of delirium in burn intensive care unit patients. Journal of Burn Care and Research, 31(5), 706-15. doi: 10.1097/BCR.0b013e3181eebee9.
3 Zhang, H., Lu, Y., Liu, M., Zou, Z., Wang, L., Xu, F. Y., & Shi, X. Y. (2013). Strategies for prevention of postoperative delirium: A systematic review and meta-analysis of randomized trials. Critical Care, 17(2), 1-21.
4 Kolanowski, A., Fick, D., Clare L., Therrien, B., & Gill, D. (2010). An intervention for delirium superimposed on dementia based on cognitive reserve. Aging & Mental Health, 14(2), 232-242. doi: 101080/136907860903167853
5 Martinez, F., Tobar, C., & Hill, N. (2015). Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age and Ageing, 44(2), 196-204. doi: 101093/ageing/aful73
6 Rivosecchi, R. M., Smithburger, P. L., Svec, S., Campbell, S., & Kane-Gill, S. L. (2015). Non-pharmacological interventions to prevent delirium: An evidence-based systematic review. Critical Care Nurse, 35(1), 39-51.