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Review
. 2014 Mar 8;383(9920):911-22.
doi: 10.1016/S0140-6736(13)60688-1. Epub 2013 Aug 28.

Delirium in elderly people

Sharon K Inouye  1 , Rudi G J Westendorp  2 , Jane S Saczynski  3
Affiliations
Review

Delirium in elderly people

Sharon K Inouye et al. Lancet. .

Abstract

Delirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows that pharmacological prevention or treatment is effective. Drug reduction for sedation and analgesia and non-pharmacological approaches are recommended. Delirium offers opportunities to elucidate brain pathophysiology--it serves both as a marker of brain vulnerability with decreased reserve and as a potential mechanism for permanent cognitive damage. As a potent indicator of patients' safety, delirium provides a target for system-wide process improvements. Public health priorities include improvements in coding, reimbursement from insurers, and research funding, and widespread education for clinicians and the public about the importance of delirium.

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Conflict of interest statement

Conflicts of interest

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Multifactorial model of delirium in older persons
The onset of delirium involves a complex interaction between the patient’s baseline vulnerability (predisposing factors) present on admission, and precipitating factors or noxious insults occurring during hospitalization. See text for details.
See this image and copyright information in PMC

Comment in

  • Delirium in elderly people.
    Naeije G, Pepersack T. Naeije G, et al. Lancet. 2014 Jun 14;383(9934):2044-2045. doi: 10.1016/S0140-6736(14)60993-4. Lancet. 2014. PMID: 24931688 No abstract available.
  • Delirium in elderly people--authors'reply.
    Inouye SK, Westendorp RG, Saczynski JS, Kimchi EY, Cleinman AA. Inouye SK, et al. Lancet. 2014 Jun 14;383(9934):2045. doi: 10.1016/S0140-6736(14)60994-6. Lancet. 2014. PMID: 24931690 No abstract available.

References

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