Delirium, Confusion and Assessing a Confused Patient
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Table of Contents
1 in 5 elderly patients on medical and surgical wards are affected by delirium at any one time.1 Delirium is a symptom of an underlying cause which needs to be elucidated and treated. It is also important to differentiate between delirium, depression and dementia – something which can be incredibly difficult in practice.
Delirium: an acute, transient and reversible state of confusion, usually the result of other organic processes (infection, drugs, dehydration), the onset is acute and the cognition of the patient can be highly fluctuant over a short period of time.
There are 2 main types of delirium:
Note that fluctuation between the two is common.
This is the ‘typical’ delirium picture:
Hypoactive delirium is much easier to miss.
Often this type of delirium can be confused with depression.
Slowness with everyday tasks
Causes and Risk factors
A change in environment coupled with sensory impairment (common in the elderly) increases the risk of developing delirium. These factors alone can cause delirium without any deeper organic cause, but this should only be considered as a diagnosis of exclusion. Things that can cause or lead to delirium include pretty much anything, ever. Some of the biggies are listed below. I’m generally not a fan of acronyms for the sake of acronyms, but CHIMPS PHONED is a useful reminder that it is not just our old friend UTI that should be considered:
Organ dysfunction (hepatic or renal impairment)
Drugs (over the counter, illicit, recreational, their partner/neighbour/pets’, alcohol and smoking)
Assessment of the confused patient
Clues from the medical notes
Current diagnoses – consider dementia and depression as standalone causes or in conjunction with delirium