Managing the Care of the Older Patient with Delirium and Dementia

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Key points

  • Nurses are on the frontline of health care and can identify symptoms that assist in distinguishing symptoms or delirium and dementia and provide appropriate interventions.

  • Delirium and dementia pose serious human and financial burdens, including morbidity/mortality, lengthened hospitalizations, increased staff demands, safety deficits, and decline in patient and caregiver quality of life.

  • Efforts to facilitate health resolution and restore the patient and caregivers to an optimal level of

Prevalence and cost of cognitive disorders

Delirium and other cognitive disorders are common, costly, and morbid, particularly among older adults. Delirium is a medical emergency that requires immediate evaluation and management to reduce its potential negative sequelae. Nurses are in pivotal, frontline positions to enable them to recognize high-risk older adults and initiate interventions that promote healthy outcomes for the patient presenting with delirium and various dementias.

Delirium

Delirium is a prevalent complication of acute medical conditions, particularly in older adults. In the general population, 1% to 2% of people aged 65 and older have delirium,3 but rates increase with age, with delirium occurring in up to 14% of people greater than age 85.4 Delirium occurs in 10% to 30% of geriatric patients in emergency departments,5 and in more than 60% of nursing home residents.4 Contributing factors include systemic disorders, such as infection, metabolic disturbances, and

Dementia

The 5th edition of the Diagnostic and Statistical Manual retired “dementia” in favor of major neurocognitive disorder. However, dementia is still acceptable for use in etiologic subtypes where the term is standard and is the diagnostic descriptor used in this article.11

Dementia, similar to delirium, is a clinical syndrome characterized by acquired losses of cognitive and emotional abilities that interfere with the patient’s level of functioning and quality of life. Up to 5 million Americans had

Summary

As the population ages, nurses in various clinical settings must identify high-risk groups that are vulnerable to delirium and dementia. They also must be able to provide psychosocial and pharmacologic interventions that promote comfort and safety for the patient and their families experiencing these distressful medical conditions. Efforts to facilitate healthy resolution and restore the patient and caregivers to an optimal level of function must be priorities.

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  • Cited by (1)

    This article is an update of an article previously published in Nursing Clinics of North America, Volume 38, Issue 1, March 2003.

    Disclosure Statement: The authors have nothing to disclose.

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