Kevin Biese, an expert in geriatric emergency medicine and author on delirium, shares invaluable insights on managing delirium in older adults. He discusses the critical signs and symptoms that often go unnoticed, the importance of accurate diagnosis, and practical tips for prevention. Biese explains how to differentiate delirium from dementia, and highlights challenges in treating agitated patients. With case studies and advanced management strategies, he provides a comprehensive look at improving care for older adults in emergency settings.
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Delirium as a Vital Sign
Delirium in older adults signals an underlying medical issue, not worsening dementia.
Recognizing delirium as a vital sign prompts investigation into the root cause.
volunteer_activism ADVICE
Diagnosing Delirium
Use the Brief Confusion Assessment Method (BCAM) to diagnose delirium in the ED.
If a screening program isn't available, providers can still identify delirium through observation.
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Confirming Delirium
Determine if the confusion is acute or fluctuating by contacting someone who knows the patient's baseline.
Look for inattention, disorganized thinking, or altered consciousness levels to confirm delirium.
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Kevin Biese describes the signs and symptoms of delirium in older adults, and drops some pearls on how to manage it safely.
For the shownotes and blog site, see: http://gempodcast.com/2015/11/11/diagnosing-and-managing-delirium-in-older-adults/
Welcome to GEMCAST! In this inaugural episode, first published 09/2015, Kevin Biese talks us through some practical tips for preventing, identifying, and managing delirium in older adults in the Emergency Department.
Delirium is incredibly common among older adults in the ED, but is easy to miss. It is also an independent predictor of 6 month mortality. How is it diagnosed? Why does it matter that we identify it? How can you prevent it? How do you safely treat symptoms of agitation in an older adult? How can you differentiate it from dementia in the acute care setting? – Take a listen.
References:
1. Barrio K, Biese K. Delirium, dementia, and other mental health disorders of older adults. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli’s emergency medicine: A comprehensive study guide. 8th ed. ; 2011. Accessed 07/23/2015.
2. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. PMID: 23992774
3. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823-832. PMID: 26139023
4. Han JH, Eden S, Shintani A, et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med. 2011;18(5):451-457. PMID: 21521405
5. Han JH, Shintani A, Eden S, et al. Delirium in the emergency department: An independent predictor of death within 6 months. Ann Emerg Med. 2010;56(3):244-252.e1. PMID: 20363527
6. Han JH, Wilson A, Vasilevskis EE, et al. Diagnosing delirium in older emergency department patients: Validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013;62(5):457-465. PMID: 23916018
7. Marcantonio ER. Delirium. In: Pacal JT, Sullivan GM, eds. Geriatrics review syllabus: A core curriculum in geriatric medicine. 7th ed. New York, NY: American Geriatrics Society; 2010
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