Delirium Management In Older Persons: Issues And Recommendations

Cognitive impairment in older persons

Discuss about the Educational Interventions To Improve Recognition.

Cognitive impairment is a condition of illness in which a person faces difficulties in remembering, concentrating and learning things and lacks ability of taking decisions in their regular life (Rock et al., 2014). The symptoms affect the daily life of the patient in an effective way. Older people are more prone to the symptoms of cognitive impairment (Mitchell et al., 2014). There are different forms of cognitive impairment such as dementia, delirium and depression (Freitas et al., 2013). The chosen form of cognitive impairment for the essay is delirium. The following paper will provide a brief idea about the relevant issue regarding delirium, evidence supporting the issue, recommendations related practice and clinical situation, evaluation of such recommendation regarding quality, clinical relevance and applicability, nursing recommendations and a summary of the findings for face-to-face tutorials.

There are many issues related to delirium in adults and older people. One of the main issues regarding the older person is delirium management of older people in hospital. Delirium is common in the hospitalized patients, mostly in the older person (Kalish,  Gillham & Unwin, 2014). The main problem is to recognize the illness, as the symptoms are alike dementia. The fluctuating nature of the person makes it difficult to recognize the proper symptoms (Gélinas et al.,2013). Thus, clinicians face some complexity to understand that whether the person is suffering from delirium or dementia. The main reason of such difficulties is the use of inadequate cognitive assessment and poor management in the hospital (Freitas, S., Simões, Alves & Santana, 2013). It is important to diagnose the disease properly as a patient with delirium has high mortality rate. Hence, the poor delirium recognizing process and the hospital management become a headache in order to manage older person with delirium.

Best Practice Recommendation 1:

Proper diagnosis of delirium is important as the condition may lead to end of life issue in the older people. Diagnosis need to be done in the basis of history of the patient, because in many cases the symptoms arise due to effect of some past head injury, stroke or other accidents. Hence, mental status assessment and some physical and neurological tests are required to determine the nature of the illness. Cognitive testing need to be provided to the patient to understand the different risk factors and to differentiate between dementia and delirium (Hosie et al., 2013)

Delirium in older persons

The recommendation is not based on high quality evidence. Many questions can be raised regarding the clinical guideline. For example, whether the screening process is cost effective or not, if it is acceptable to the patient and the role of such screening in decreasing the mortality rate. However, researchers have stated that such screening test is important to understand the severity of delirium and provide effective treatment to the patient.

The recommendation regarding proper diagnosis of delirium is highly recommended in the clinical practice. Cognitive test of every old age patient in the hospital before admission is important to identify delirium within him or her. It will help to understand the severity of the illness. The process can be proved efficient in reducing the severe outcomes of delirium in older person.

The quality of the evidence not high, still it can be applied as clinical process regarding the cure of delirium. It is important to recognize the nature of the disease in order to cure it. Thus, without appropriate evidence,  it is applicable to address the issue of delirium management in older person in the hospital.

Prevention of delirium can decrease the rate of delirium in the older persons. Prevention process needs to be done from the admission of the patient to throughout the stay. The target area of the prevention process should be the risk factors of delirium (Abraha, 2016). Some non-pharmacological process can be used as prevention of delirium, such as inspire the patient for normal sleep-wake practice, allowing visit of the family members, less changes in the nursing staff, mobilization and providing patient friendly environment in the hospital (Devlin & Pohlman, 2014).

The quality of the recommendation is moderate. It is not ensured that such method can prevent the risk factors of delirium, but according to the experts, such process of prevention can reduce the incidence of delirium to an extent. Thus, the recommendation can be proved helpful in managing delirium.

The recommendation regarding prevention of delirium is mostly acceptable in the clinical practice. If prevention process is done to every older person in the hospital, the risk of suffering from delirium may be reduced. Thus, providing better environment and care in order to prevent delirium in older person in the hospital from beginning is one of the best recommendations in clinical practice.

The recommendation is highly acceptable in clinical practice as the process is low cost effective. Such prevention process can decrease the number of incidents of delirium in the older person. If the process cannot prevent the illness from being occurred, it can still reduce the functional decline in the patient. Hence, the recommendation is acceptable to the clinicians and the patients as well in order to solve the issue of delirium management.

Management of delirium in older persons

There is a risk factor of falls in the older persons with delirium. People with delirium are more prone to falls; approximately, twice than a person who is cognitively intact (Zaal et al., 2015). The falls may result in fatal or non-fatal injury. Functional recovery of the injury is difficult for the person suffering from delirium (Winter, Watt & Peel, 2013). It is important to take care of such person in an effective manner .Thus, fall prevention interventions are required to reduce the risk factor. Knowledgeable caregiver is needed to manage such older persons.

High quality evidences are not available for the recommendation. The numbers of interventions that can be used in order to prevent the risk of fall in the older person with delirium are limited. However, study has proved that, interventions for prevent the risk of fall is important as it can cause mild to severe injury. Use of reliable and valuable process to prevent falls is important. The recommendation is useful with the support of experts.

The recommendation of falls prevention interventions is relevant to clinical practice. Older person with delirium, especially over 75 years age, are more prone to falls. Proper caregiver is required to pay attention to such person. Implementation of the recommendation can be proved beneficial for managing older people with delirium in the hospital.

However, there are very few evidences regarding falls prevention interventions, but it is important to apply this recommendation in the clinical practice. Such interventions could reduce the risk of falls in the older persons. Thus, best practice recommendation 3 is applicable in order to counter the issue of managing older person with delirium in hospital.

Medication for delirium is not always applicable, but in case of severe delirium in older person, medication is provided in order to reduce the severity of the illness. To control the aggressiveness of the patients, antipsychotic medication such as Haloperidol can be provided (Meagher et al., 2013).

The quality of the evidence not high, as there is limited information in the evidence. Side effects of the medication are not mentioned properly. Still the recommendation is useful, as many knowledgeable experts have supported the evidence with their concern.

The recommendation is relevant to the clinical practice. Antipsychotic medication is useful in controlling the aggressiveness of the patient. It is important for the clinicians to know the limitations of the medication.

The best recommendation 4 is applicable in clinical practice in order to control the aggressive patients. Though medication is not always needed for every person with delirium, but in case of older people with severe illness, the medication is helpful.

Best practice recommendations for managing delirium in older persons

People are not informed properly about delirium and its effects. It is important to provide proper information regarding delirium to every people, so that they can understand the importance of the treatment. The information that will be provided should be collect considering culture and ethics. It will help individual to accept the treatment procedure (Yanamadal, Wieland & Heflin, 2013).

The evidence for best recommendation 4 is appropriate. The evidence has provided importance of intervention of education in order to make it understandable to all. However, the information needs to be acceptable to all.

The recommendation is relevant to clinical practice as information provided by the clinicians to the patients and their families will help them to understand the condition of the patient in a better way.

Providing knowledge is something that is applicable in any field. Application of such recommendation is useful to expand the information about delirium prevention or treatment. It will help to create awareness about the illness and clear confusion regarding this.

Post-operative delirium occurs in older people after major surgery. Study has shown that older person with gastrointestinal surgery are more prone to post-operative delirium (Scholz et al., 2016). There are many ways of managing such patients. It is important to provide enough fluid to an older person in order to avoid dehydration. Proper dressing is required after surgery to prevent infection. The nurses should make sure that patients are walking multiple times per day. Orientation of the patient to their known location is important. The nurses should remain aware of minimizing the use of medicine for sleep. Non-opioid medication can be provided to the patients in order to minimize the pain. There is no proper evidence regarding the treatment of post-operative delirium. However, treatment of post-operative delirium is important as it can affect both physical and mental health of the patient and even can cause death (Bilotta et al., 2013).

The recommendations could play an important role in improving the process of nursing management. Proper diagnosis is an important factor to resolve the issue of delirium management and it will help the nurses to understand the nature of the illness (Grassi et al., 2015). Non-pharmacological treatment is important to prevent or reduce the risk factors of delirium and it could help to reduce the headache of the management by reducing the number of incidence of delirium. Proper information provided by the clinicians will help the patient to understand treatment process and it will decrease the difficulties of the nurses in providing care.

Reference:

Abraha, I., Rimland, J. M., Trotta, F., Pierini, V., Cruz-Jentoft, A., Soiza, R., … & Cherubini, A. (2016). Non-pharmacological interventions to prevent or treat delirium in older patients: clinical practice recommendations the SENATOR-ONTOP series. The journal of nutrition, health & aging, 20(9), 927-936.

Bilotta, F., Lauretta, M. P., Borozdina, A., Mizikov, V. M., & Rosa, G. (2013). Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol, 79(9), 1066-1076.

Devlin, J. W., & Pohlman, A. S. (2014). Everybody, every day: an “awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility” culture is feasible in your ICU. Critical care medicine, 42(5), 1280-1281.

Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2013). Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Disease & Associated Disorders, 27(1), 37-43.

Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2013). Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Disease & Associated Disorders, 27(1), 37-43.

Gélinas, C., Klein, K., Naidech, A. M., & Skrobik, Y. (2013). Pain, sedation, and delirium management in the neurocritically ill: lessons learned from recent research. In Seminars in respiratory and critical care medicine (Vol. 34, No. 02, pp. 236-243). Thieme Medical Publishers.

Grassi, L., Caraceni, A., Mitchell, A. J., Nanni, M. G., Berardi, M. A., Caruso, R., & Riba, M. (2015). Management of delirium in palliative care: a review. Current psychiatry reports, 17(3), 13.

Hosie, A., Davidson, P. M., Agar, M., Sanderson, C. R., & Phillips, J. (2013). Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliative medicine, 27(6), 486-498.

Kalish, V. B., Gillham, J. E., & Unwin, B. K. (2014). Delirium in older persons: evaluation and management. Am Fam Physician, 90(3), 150-8.

Meagher, D. J., McLoughlin, L., Leonard, M., Hannon, N., Dunne, C., & O’Regan, N. (2013). What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy. The American Journal of Geriatric Psychiatry, 21(12), 1223-1238.

Mitchell, A. J., Beaumont, H., Ferguson, D., Yadegarfar, M., & Stubbs, B. (2014). Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta?analysis. Acta Psychiatrica Scandinavica, 130(6), 439-451.

Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological medicine, 44(10), 2029-2040.

Scholz, A. F. M., Oldroyd, C., McCarthy, K., Quinn, T. J., & Hewitt, J. (2016). Systematic review and meta?analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. British Journal of Surgery, 103(2).

Winter, H., Watt, K., & Peel, N. M. (2013). Falls prevention interventions for community-dwelling older persons with cognitive impairment: a systematic review. International psychogeriatrics, 25(2), 215-227.

Yanamadala, M., Wieland, D., & Heflin, M. T. (2013). Educational interventions to improve recognition of delirium: a systematic review. Journal of the American Geriatrics Society, 61(11), 1983-1993.

Zaal, I. J., Devlin, J. W., Peelen, L. M., & Slooter, A. J. (2015). A systematic review of risk factors for delirium in the ICU. Critical care medicine, 43(1), 40-47.

Order an Essay Now & Get These Features For Free:

Turnitin Report

Formatting

Title Page

Citation

Outline

Place an Order