Delirium in Hospitalized Older Adults

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KEY CLINICAL POINTSDELIRIUM IN HOSPITALIZED OLDER ADULTSDelirium is an acute confusional state that is extremely common among hospitalized elders and is strongly associated with poor short-term and long-term outcomes.The risk of delirium can be assessed according to the presence of predisposing (baseline) and precipitating (acute) factors. The more predisposing factors that are present, the fewer precipitating factors that are required to cause delirium.The first step in delirium management is accurate diagnosis; a brief validated instrument that assesses features in the Confusion Assessment Method algorithm is recommended.After receiving a diagnosis of delirium, patients require a thorough evaluation for reversible causes; all correctable contributing factors should be addressed.Behavioral disturbances should be managed with nonpharmacologic approaches first. If required for patient safety, low doses of high-potency antipsychotic agents are usually the treatment of choice (off-label use). Treatment should be targeted to specific behaviors and stopped as soon as possible.Proactive, multifactorial interventions and geriatrics consultation have been shown to reduce the incidence, severity, and duration of delirium.

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