Author: Susan Gorman, MSN, RN, GNP & Kathleen Pace Murphy, PhD, MS
Delirium is often a symptom of a serious illness in older adults; and sometimes the only presenting symptom.
Delirium is associated with prolonged hospitalization, functional decline, and increased use of chemical and physical restraints.Factors that precipitate delirium can be remembered using the mnemonic DELIRIUM:
Drug use (hypnotics, anticholinergic)
Lack of drugs (withdrawal)
Reduced sensory input (blindness, deafness
Intracranial problems (stroke)
Urinary retention and fecal impaction
Myocardial problems (MI, heart failure, arrhythmias).
Delirium assessment includes utilizing the Confusion Assessment Method (CAM) developed by Sharon K. Inouye (2006).
The CAM has 4 Features:
The following table is helpful in distinguishing dementia from delirium:
|Dementia and Delirium Comparative Table|
|Onset||Insidious||Rapid associated with an identified event|
|Main symptom||Loss of memory, especially recent event(s)||Inattention|
|Etiology||May be related to underlying brain disorder, such as Alzheimer disease, vascular dementia, or Lewy body dementia||Nearly always related to underlying acute change, such as dehydration, infection, or starting or stopping medications|
|Level of consciousness||May be normal until advanced stages||Fluctuates|
|Language||May be problematic with word choices||Slowed or rapid speech, frequently with incoherent and/or inappropriate language|
|Progression||Slow||Causes variations in mental function- people are alert one moment and sluggish and drowsy the next|
|Development||Often permanent||Fluctuates; days to weeks to months|
|Treatment||Needed; slows progression but does not cure||Immediate; usually reversible|
Table Source: Ehlenbach, Hough, Crane, Haneuse, Carson, Randall, & Larson, (2010); Fong, Tubevaev, & Inouye, (2009); Inouye (2006a) (2006b).
Identify and treat the underlying cause of delirium (i.e. infection, drugs, electrolyte imbalance).
Reassure the patient by having well known family members or caregivers at the bedside.
Discern day from night surroundings (decreased stimulation at night to promote sleep; blinds open during day with more activity).
Avoid bed rest if possible and the use of restraints (chemical or physical).Encourage interprofessional interventions:
Additional Web-based educational resources:
Delirium: Acute Confusional State. Pub Med Health (2013):
YouTube: How to recognize delirium
Ehlenbach, W.J., Hough, C.L., Crane, P.K., Haneuse, S.J.P.A., Carson, S.S., Randall Curtis, J., & Larson, E.B. (2010). Association between acute care and critical illness hospitalization and cognitive function in older adults. Journal of American Medical Association, 303(8), 763-770.
Fong, T.G., Tubevaev, S.R., & Inouye, S.K. (2009). Delirium in elderly adults: Diagnosis, prevention and treatment. National Review of Neurology, 5(4):210-220. Doi:10.1038/nrneurology.209.24. Retrieve from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/
Inouye, S. (2006a). Delirium in older persons. New England Journal of Medicine, 354(11), 57-65.
Inouye, S. (2006b). Geriatrics At Your Fingertips (9th Ed.) New York: The American Geriatrics Society.