Delirium en los pacientes mayores

  1. Espeso, E.A. Rodríguez
  2. Mateos-Nozal, J.
  3. García, E.M. Sánchez
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2022

Título del ejemplar: Enfermedades geriátricas

Serie: 13

Número: 62

Páginas: 3649-3658

Tipo: Artículo

DOI: 10.1016/J.MED.2022.08.011 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

Delirium is a clinical syndrome characterized by transitory changes in level of consciousness that has an acute onset and fluctuating course and is associated with cognition and behavior changes. It tends to occur secondary to organic causes (infections or drugs) and is very prevalent in hospitalized older adults. It is classified as hypoactive, hyperactive, or mixed. Its diagnosis is fundamentally clinical. Several rapid diagnostic tools have been validated (4AT, CAM) which complement the clinical assessment. Multicomponent non-pharmacological interventions have been demonstrated to be the most effective in both its prevention and its treatment. The key point in treatment is treating the triggering causes. Pharmacological control could be justified when the patient's or healthcare team's safety is compromised or when symptoms cause the patient great emotional stress. Neuroleptics are the most used drugs. The drug with the most favorable side effects profile according to each patient's characteristics should be chosen and they should be used for the shortest possible time.

Referencias bibliográficas

  • Adamis D, Treloar A, Gregson N, Macdonald AJD, Martin FC. Delirium and the functional recovery of older medical inpatients after acute illness: the significance of biological factors. Arch Gerontol Geriatr. 2011;52(3): 276-80.
  • Bliwise DL. What is sundowning? J Am Geriatr Soc. 1994;42(9):1009-11.
  • Chen P, Dowal S, Schmitt E, Habtemariam D, Hshieh TT, Victor R. Hospital Elder Life Program in the real world: the many uses of the Hospital Elder Life Program website. J Am Geriatr Soc. 2015;63(4):797-803.
  • Cole MG, Ciampi A, Belzile E, Dubuc-Sarrasin M. Subsyndromal delirium in older people: a systematic review of frequency, risk factors, course and outcomes. Int J Geriatr Psychiatry. 2013;28(8):771-80.
  • Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry. 2004;12(1):7-21.
  • Cole MG, Primeau FJ. Prognosis of delirium in elderly hospital patients. CMAJ. 1993;149(1):41-6.
  • Collins N, Blanchard MR, Tookman A, Sampson EL. Detection of delirium in the acute hospital. Age Ageing. 2010;39(1):131-5.
  • Dasgupta M, Hillier LM. Factors associated with prolonged delirium: a systematic review. Int Psychogeriatr. 2010;22(3):373-94.
  • De Lange E, Verhaak PFM, van der Meer K. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. Int J Geriatr Psychiatry. 2013;28(2):127-34.
  • Diagnostic and statistical manual of mental disorders: DSM-5. 5th edition. Arlington, VA: American Psychiatric Association; 2013. p. 947.
  • Durán CE, Azermai M, Vander Stichele RH. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol. 2013;69(7):1485-96.
  • Egberts A, Alan H, Ziere G, Mattace-Raso FUS. Antipsychotics and Lorazepam During Delirium: Are We Harming Older Patients? A real-life data study. Drugs Aging. 2021;38(1):53-62.
  • FitzGerald JM. Delirium clinical motor subtypes: a narrative review of the literature and insights from neurobiology. Aging Ment Health. 2018; 22(4):431-43.
  • Garcez FB, Avelino-Silva TJ, Castro REV de, Inouye SK. Delirium in older adults. Geriatr Gerontol Aging. 2021;15(0):1-12.
  • Hshieh TT, Inouye SK. Delirium in the elderly. Clin Geriatr Med. 2020;36(2):183-99.
  • Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669-76.
  • Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13(4):234-42.
  • Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-8.
  • Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet Lond Engl. 2014;383(9920):911-22.
  • MacLullich AM, Shenkin SD, Goodacre S, Godfrey M, Hanley J, Stíobhairt A. The 4 ’A’s test for detecting delirium in acute medical patients: a diagnostic accuracy study. Health Technol Assess Winch Engl. 2019;23(40):1-194.
  • Maldonado JR. Acute brain failure: Pathophysiology, diagnosis, management, and sequelae of delirium. Crit Care Clin. 2017;33(3): 461-519.
  • Maybrier HR, Mickle AM, Escallier KE, Lin N, Schmitt EM, Upadhyayula RT. Reliability and accuracy of delirium assessments among investigators at multiple international centres. BMJ Open. 2018;8(11): e023137.
  • McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med. 2002;162(4):457-63.
  • McCusker J, Cole M, Dendukuri N, Han L, Belzile E. The course of delirium in older medical inpatients: a prospective study. J Gen Intern Med. 2003;18(9):696-704.
  • Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: Advances in diagnosis and treatment. JAMA. 2017;318(12):1161-74.
  • Sheth RD, Drazkowski JF, Sirven JI, Gidal BE, Hermann BP. Protracted ictal confusion in elderly patients. Arch Neurol. 2006;63(4):529-32.
  • Thom RP, Mock CK, Teslyar P. Delirium in hospitalized patients: Risks and benefits of antipsychotics. Cleve Clin J Med. 2017; 84(8):616-22.
  • Tieges Z, Maclullich AMJ, Anand A, Brookes C, Cassarino M, O’connor M. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing. 2021;50(3):733-43.
  • Vidán MT, Sánchez E, Alonso M, Montero B, Ortiz J, Serra JA. An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients. J Am Geriatr Soc. 2009;57(11):2029-36.
Fuente de los datos: Dialnet