Delirium in the ED: How can we help?
Presented by: Dr Cherie-Lee Adams
Incidence of Delirium
- 40% admitted patients >65yo
- 10-20% on admission
- 5-10% more during admission
Increased Risk of Delirium:
- Male
- >60yo, more prevalent >80yo
- Hearing/visual impairment
- Dementia
- Depression
- Functional dependence
- Polypharmacy
- Major medical/surgical illness
DSM-V Criteria
- A) Disturbance in attention and awareness
- B) Disturbance is ACUTE
- C) Concurrent cognitive impairment
- D) Not evolving dementia, nor coma
- E) Can be explained by Hx/Px/Ix
Non – Pharmacological Approach
- Nutritional support
- Optimize hearing/sight
- Maximize day/night/date/time cues
- Minimize pain
- Rehabilitate- ambulate, encourage self-care
- Avoid restraints
Pharmacological Options
- Treat only if distress/agitated/safety concern
- don’t treat hypoactive delirium, wandering, or prophylactically
- monotherapy
- low dose
- short course
- Benzos- reserve for withdrawal
- APs
- Haldol 0.25-0.5mg
- risperidone 0.25mg od-bid
- olanzapine 1.25-2.5mg/d
- quetiapine 12.5-50mg/d
Take Home Points
- Delirium is common, esp in elderly
- Significant morbidity/mortality associated
- Brief screening with DTS/bCAM works
- Intervention focus on limiting pathology, normalizing activities, minimizing drugs
- Low dose APs for short period for agitation