Delirium in hospitalized older patients: Recognition and risk factors

Delirium, or acute confusional state, represents a common, serious, potenti ally preventable and increasing problem for older hospitalized patients. Th is study is intended to improve overall understanding of the problem of del irium and thus to lessen its adverse impact on the older population. The sp ecific aims of this study are (1) to examine the epidemiology of delirium i n older patients; (2) to evaluate barriers to recognition; (3) to present t he Confusion Assessment Method (CAM) simplified algorithm to improve recogn ition; (4) to elucidate predisposing and precipitating factors for delirium ; and (5) to propose preventive strategies. Delirium occurs in 10-60% of th e older hospitalized population and is unrecognized in 32-66% of cases. The CAM algorithm provides a sensitive (94-100%), specific (90-95%), reliable, and easy to use means for identification of delirium. Four predisposing an d Rye precipitating factors were identified and validated to identify patie nts at high risk for development of delirium. Primary prevention of deliriu m should address important delirium risk factors and target patients at int ermediate to high risk for delirium at admission.