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

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