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Nurses should be aware of patients who have one or more risk factors for incident delirium

Delirium study highlights the need for nurses to have an understanding of patient history to identify risk factors associated with the condition.

Delirium is a disturbance of attention and cognition that cannot be explained by a pre-existing neurocognitive disorder.

It can have serious consequences including falls, increased mortality, longer hospital stay and increased risk of long-term cognitive impairment.

Delirium may be present on admission to hospital but, where it is not, nurses need to identify people at risk.

Multifactorial

Delirium is a complex syndrome that may be due to the interaction of physiological illness and pre-existing risk factors. Various theories, including reduced blood flow due to ageing, dysfunction of metabolism in the brain, cholinergic deficiency and overreaction of the bodys natural stress response, have attempted to explain the physiological process, but the actual neurological process remains unclear. In older people, the cause is usually multifactorial.

This study looked at the case

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Delirium is a disturbance of attention and cognition that cannot be explained by a pre-existing neurocognitive disorder.


Delirium can often present in older people who have dementia. Picture: Alamy

It can have serious consequences including falls, increased mortality, longer hospital stay and increased risk of long-term cognitive impairment.

Delirium may be present on admission to hospital but, where it is not, nurses need to identify people at risk.

Multifactorial 

Delirium is a complex syndrome that may be due to the interaction of physiological illness and pre-existing risk factors. Various theories, including reduced blood flow due to ageing, dysfunction of metabolism in the brain, cholinergic deficiency and overreaction of the body’s natural stress response, have attempted to explain the physiological process, but the actual neurological process remains unclear. In older people, the cause is usually multifactorial.

This study looked at the case notes of 161 patients who developed delirium while in hospital and 321 case notes of those without delirium who made up the controls. The findings show that those who had previously had delirium had greater odds of developing the condition than those who had not.

Patients who had a diagnosis of dementia also had an increased risk of developing delirium. Having a fracture on admission or functional impairment significantly increased a patient’s likelihood of developing delirium, but old age alone was not a significant risk factor.

Identifying history

The researchers conclude that nurses should be vigilant about speaking to patients and their families about any cognitive impairment and history of delirium to identify those who are at greatest risk and prevent harmful consequences.


Tomlinson E, Phillips N, Mohebbi M et al (2017) Risk factors for incident delirium in an acute general medical setting: a retrospective case-control study. Journal of Clinical Nursing. 26, 5-6, 658-667.

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