Delirium; It is a geriatric syndrome that can occur for many different reasons, has a fluctuating course, and is accompanied by confusion, anxiety, confusion, perception, thought disorders, and sleep-wake cycle changes.
In Latin, it means leaving the midline, leaving normality, and It has been known in the medical literature for about 2000 years. We can also see that it is called by various names such as acute organic brain syndrome, acute organic cognitive disease and toxic confusional state.
10-30% of hospitalized elderly people are diagnosed at the time of admission, and 60% of elderly people living in nursing homes are diagnosed with terminal illness at some point in time. It has been recorded that 90% of patients in this period show symptoms of delirium in their last weeks.
Delirium is a life-threatening syndrome that is frequently seen in elderly individuals, causes an increase in mortality and morbidity rates, and is partially preventable, but it is not well known by healthcare personnel in the literature. and it is stated that it is not managed well.
In addition to increasing mortality, it reduces functional abilities, increases the need for long-term care and prolongs the duration of hospital stay
Impairment in attention and cognitive impairment. Loss of function constitutes the main elements of the delirium clinic. Symptoms typically appear over a short period of time and fluctuate throughout the day. While patients may be seen as extremely tired, dizzy or even in a semi-comatose state, the opposite may be observed in the clinic in a state of hyperalertness, which is less common in the elderly population, especially in alcohol and sedative drug withdrawal. Changes in the level of awareness and impairments in the ability to focus or sustain attention are usually the first signs of delirium. Disorientation is quite common. Inability to accurately tell the time, day, month, or where one is, not being able to recognize people around, talking as if one is at home, or talking about deceased relatives may be observed. Distraction can often be noticed in patients during conversation. Carefully examine the flow of speech during a conversation and attribute disturbances in the flow of speech to the patient's age, fatigue or history of dementia. food is important. It can also occur in the form of auditory and sensory hallucinations (stating that one feels like insects are crawling around his body), misinterpretation (any machine alarm can be interpreted as a police siren), optical illusion (perceiving the folds of blankets as moving objects). Patients experiencing delirium may experience memory loss, disorientation, and difficulty with language and speech. A mental status test can be applied to determine this condition. The important thing here is to know the patient's previous mental state. Speech and expression disorders such as incompatible or meaningless or irrelevant speech, misnaming objects, and difficulties in understanding what is being said may be observed. It may be accompanied by sleep disorders such as inability to sleep at night, sleep disruption, sleepiness during the day, and reversal of the sleep-wake cycle. Emotional state changes ranging from anxiety, sadness, fear and euphoria may be observed. Tension, constantly trying to get out of bed, wandering around, trying to remove tubes/drains/catheters repeatedly may be observed
Pain, metabolic and electrolyte disorders, fluid loss, serious kidney and liver problems. A wide range of diseases are included in the etiology of delirium, such as deficiencies, urinary and respiratory tract infections, thyroid diseases, nutritional deficiencies, sleep deprivation, constipation, vision and hearing loss.
Delirium treatment has 2 main types. should be planned based on the element. The first of these is the treatment of the factors that cause the emergence of delirium, and the other is the treatment of behavioral disorders observed in patients.
Delirium screening is now recommended in elderly patients as an important quality indicator for geriatric care.
Read: 0
