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Dx Delirium Treatment:


The Merck Manual Home Edition states in:
Spotlight on Aging:
"Delirium is more common among older people. It is a common reason that family members of older people seek help from a doctor or at a hospital. About 15 to 50% of older people experience delirium at some time during a hospital stay". Delirium is a medical condition that has a great mortality if not diagnosed. 'Timely intervention can increase twofold the percentage of patients discharged home.'

"Delirium tends to last longer in older people. It is often the first sign of another, sometimes serious disorder. (Editor] A complete medical disorder is mandatory). Delirium and the hospitalization it usually requires can cause many other problems, such as under-nutrition, dehydration, and pressure sores.
A disorder that normally does not affect thinking, such as a urinary tract infection, influenza, or deficiency of thiamin or vitamin B12; Retention of urine or feces.
Sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid
Sleep deprivation and Stress (any type)

These problems may have serious consequences in older people. Thus, older people can benefit from treatment managed by an interdisciplinary team, which includes a doctor, physical and occupational therapists, nurses, and social workers.

Older people are much more sensitive to many drugs. In older people, drugs that affect the way the brain functions, such as sedatives, are the most common cause of delirium. However, drugs that do not affect brain function, including many over-the-counter drugs (especially antihistamines, cough medications)([Editor] prescription drugs for asthma, depression, urinary frequency, anti-depressants,...), can also cause it. Older people are more sensitive.... One of these effects is confusion.

Confusion, the most obvious symptom, may be harder to recognize in older people. Younger people with delirium may be agitated, but very old people tend to become quiet and withdrawn. In such cases, recognizing delirium is even harder.

Prevention: To help prevent delirium in an older person during a hospital stay, family members can request hospital staff members help—by encouraging the person to move around regularly, by placing a clock and calendar in the room, by minimizing the interruptions and noises during the night, and by making sure the person eats and drinks enough. Family members can visit and talk with the person and thus help keep the person oriented. People with delirium may be frightened, and the familiar voice of a family member can have a calming effect...Psychosis due to a psychiatric disorder rarely begins during old age."

Medications Used in the Treatment:
1. Treat the Medical Cause
2. Roserem®/ ramelteon

We [the editorial staff] agree that a medical cause should always be sought first. Simply start with a complete blood count, metabolic panel, thyroid test, urine culture and hormonal evaluation of the adrenal and sex hormones. (See H.I.S. or H.E.R. Blood panel). A pulse oxymeter should check oxygen levels. A chest X-ray and EKG (heart test) should be considered n by a competent health professional completing the history and physical examination.

*[Editor] An excellent review from Ghent recognize that "anti-psychotic agents are often used to treat neuro-psychiatric symptoms (NPS) in dementia, although the literature is skeptical about their long-term use for this indication."

*[Editor] A recent article has documented that ramelteon for prevention of delirium in hospitalized older patient.

*[Editor] And the literature confirms that the cause of delirium is by definition, not neuro-psychiatric.

Copyrighted 2014©; Revised May 11, 2015