Delirium: A symptom of how hospital care is failing older persons and a window to improve quality of hospital care

Delirium, or acute confusional state, which often results from hospital-rel ated complications or inadequate hospital care for older patients, can serv e as a marker of the quality of hospital care. By reviewing five pathways t hat can lead to a greater incidence of delirium-iatrogenesis, failure to re cognize delirium in its early stages, attitudes toward the care of the elde rly, the rapid pace and technological focus of health care, and the reducti on in skilled nursing staff-we identify how future trends and cost-containm ent practices may exacerbate the problem. Examining delirium also provides an opportunity to improve the quality of hospital care for older persons. I nterventions to reduce delirium would need to occur at the local and nation al levels. Local strategies would include routine cognitive assessment and the creation of systems to enhance geriatric care, such as incentives to ch ange practice patterns, geriatric expertise, case management, and clinical pathways. National strategies might include providing education for physici ans and nurses to improve the recognition of delirium and the awareness of its clinical implications, improving quality monitoring systems for deliriu m, and creating environments to facilitate the provision of high-quality ge riatric care. (C) 1999 by Excerpta Medica, Inc.