Delirium Care in Hospitalized Older Adults
Is the complexity of delirium a deterrent to providing good care?
Is delirium just too difficult?
Delirium treatment in hospitalized older adults is multifaceted. Patients vary greatly in presentation—some stare blankly, others are suspicious, wary, and resistant to routine care, complicating both treatment and initial management.
BRAIN CARE: after excluding life-threatening physiological disturbances, clinicians must identify delirium triggers, understand their interactions with existing conditions, and optimize physiology. A thorough medication review is crucial to minimize drug-related brain burden.
MIND CARE: involves assessing distress, paranoia, hallucinations, and mood disturbances—commonly described as terrifying. Even without severe distress, reassurance and clear explanations are beneficial, reducing confusion.
Informing patients of their delirium diagnosis during the episode often significantly helps them understand their experiences. Communication with carers is equally essential, providing critical support during a distressing period.
Continued care involves regular reassessment, avoiding complications such as dehydration or pressure sores, and promoting rehabilitation like mobilization.
Follow-up is vital. Many patients with delirium have undiagnosed dementia; identifying cognitive decline prior to hospitalization aids diagnosis. Those with severe delirium may experience prolonged post-traumatic stress symptoms requiring counseling.
Is complexity deterring good delirium care?
Other acute conditions, like kidney injury or pneumonia, typically involve simpler diagnostic and treatment pathways. Perhaps the perceived complexity of delirium care discourages clinicians.
Could this complexity be a factor why some doctors avoid making a diagnosis? Because a diagnosis means a lot of work?
In my opinion, doctors and other professionals need to go 'all-in' when treating delirium.
Yes, it's an intellectual challenge, but that's what we are there for. It's nothing less than our duty.
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