Delirium
10
Key Points
➤ Delirium is a medical emergency – it may be the only manifestation of
a life-threatening illness.
➤ Delirium is missed in 60% of cases.
2
➤ The prevalence and incidence of delirium in post-acute/long-term
care (PALTC) is 14% and 20-22% respectively. Up to 4 out of 5
persons will have delirium at the time of death.
3
➤ Delirium that begins in hospital can continue for weeks to months.
4
➤ Patients with delirium have a higher risk of dying – risk ratio (RR)
of 4.9 in PALTC, and RR of 2 after a stroke or 5.4 if there is also a
diagnosis of dementia.
2
➤ Delirium can also lead to long-term functional decline, cognitive
impairment, permanent nursing home placement, and increased
costs.
2
➤ Delirium superimposed on dementia tends to last longer and is
associated with accelerated cognitive and functional decline,
recurrent and longer hospitalizations, nursing home placement and
death.
5
➤ At the onset of any changes in mental status from baseline a validated
delirium screening assessment should be performed. The Confusion
Assessment Method (CAM) is included in the MDS 3.0.
➤ Delirium is preventable in 30-40% of cases. Since delirium occurs as
a result of the interaction of multiple predisposing and precipitating
risk factors, a multi-component non-pharmacologic approach for
primary prevention is most effective.
2
➤ Antipsychotics do not prevent delirium, shorten the duration, or
reduce the severity of delirium. They have anticholinergic adverse
effects and increase the risk for death when used for delirium in
patients with pre-existing dementia.
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