BMJ  2007;334:968 (12 May), doi:10.1136/bmj.39199.484942.3A

Letters

Delirium in older people

Approach is now screening, prevention, and recognition

The approach to delirium has shifted from ad hoc treatment to systematic screening and prevention.¹ Management may be improved with primary prevention, early detection, and prompt management.

Preoperative cognitive impairment, as measured by the mini mental state examination or the clock drawing test, is an important predictor for postoperative delirium. Most elderly patients developing postoperative delirium after hip surgery already have early prodromal symptoms. Low dose prophylactic haloperidol can reduce the incidence.² Niam et al showed that methods proved to prevent delirium can be useful in routine clinical practice.³

In a large retrospective study only 4% of patients had a recorded diagnosis of delirium, yet an episode may occur in up to 56% of hospitalised older people.⁴ The poor understanding of delirium by staff stems from a historically low educational emphasis in medical and nursing schools. Increasing doctors' and nurses' awareness can be achieved through a brief and inexpensive educational programme, which significantly decreases the prevalence of delirium among older inpatients, increases recognition of cases, and can be easily rolled out across hospital units caring for older people.⁵

Bedfordshire and Luton Mental Health and Social Care Partnership NHS Trust, Luton LU1 2PJ

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Competing interests: None declared.

References

1. Young J, Inouye SK. Delirium in old people. BMJ 2007;334:842-6. (21 April.)[Free Full Text]
2. de Jonghe J, Kalisvaart KJ, Dijkstra M, van Dis H, Vreeswijk R, Kat MG, et al. Early symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery. Am J Geriatr Psychiatry 2007;15:112-21.[Abstract/Free Full Text]
3. Niam WT, Bruce JJ, Bruce DG. Quality project to prevent delirium after hip fracture. Australas J Ageing 2005;24:174-7.[CrossRef]
4. Kales HC, Kamholz BA, Visnic SG, Blow FC. Recorded delirium in a national sample of elderly inpatients: potential implications for recognition. J Geriatr Psychiatry Neurol 2003;16:32-8.[Abstract]
5. Tabet N, Hudson S, Sweeney V, Sauer J, Bryant C, Macdonald A, et al. An educational intervention can prevent delirium on acute medical wards. Age Ageing 2005;34:152-6.[Abstract/Free Full Text]

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Delirium in older people

John Young and Sharon K Inouye
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