DELIRIUM IN ELDERLY PATIENTS - EVALUATION AND MANAGEMENT

Objective: To review the evaluation and management of delirium in elde rly patients for primary-care providers. Design: We summarize the clin ical features, course, pathophysiologic aspects, predisposing factors, causes, and differential diagnosis of delirium and discuss approaches to affected patients and various management strategies. Results: Deli rium, an altered mental state, occurs more frequently in elderly than in younger patients. The pathophysiologic changes associated with agin g and the higher occurrence of multiple medical problems and need for medications contribute to the higher frequency of delirium in elderly patients. Evaluation should begin with a consideration of the most com mon causes, such as a change in or addition to prescribed medications, a withdrawal from alcohol or other sedative-hypnotic drugs, an infect ion, or a sudden change in neurologic, cardiac, pulmonary, or metaboli c state. Finally, management of delirium is threefold: (1) identifying and treating underlying causes, (2) nonpharmacologic interventions, a nd (3) pharmacologic therapies to manage symptoms of delirium. Conclus ion: Elderly patients frequently experience delirium. Delirious sympto ms can produce devastating consequences if they are not recognized and appropriately treated.