Management of Delirium in Critically Ill Older Adults

Author:

Balas Michele C.1,Rice Michael2,Chaperon Claudia3,Smith Heather4,Disbot Maureen5,Fuchs Barry6

Affiliation:

1. Michele C. Balas is an assistant professor at the University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska.

2. Michael J. Rice is a professor of psychiatric nursing and the associate medical director of the Behavioral Health Education Center for Nebraska at the University of Nebraska Medical Center, College of Nursing.

3. Claudia Chaperon is an assistant professor at the University of Nebraska Medical Center, College of Nursing.

4. Heather Smith was manager of core measures at New York Presbyterian Hospital, New York, New York, when this study was done. She is now program director for quality at the American Physical Therapy Association in Alexandria, Virginia.

5. Maureen Disbot is vice president of quality operations, Methodist Hospital, Houston, Texas.

6. Barry Fuchs is an associate professor, Department of Medicine, Perlman College of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients’ family members.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

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