Journal of the American Medical Directors Association
-
Delirium is a common problem in post-acute and long-term care. We present an updated review of delirium in those settings. ⋯ A work-up that focuses on the common causes of delirium (which, in essence, are the common illnesses that befall frail older adults) is likely to have a high yield. We note that preventing delirium requires a multicomponent approach, the details of much of which is known, but nevertheless have proved to be challenging to bring about in routine care.
-
Delirium occurs frequently in hospitalized patients and is reported to occur at a rate of 10% to 40% in hospitalized elderly patients. The gold standard of treatment is to treat the underlying cause of delirium and use high-potency antipsychotics such as haloperidol to target the behavioral disturbances. Since the development of atypical antipsychotics, many psychiatric conditions that were previously only treatable using high-potency antipsychotics may now be managed with the atypical agents. This review will examine the current literature on atypical antipsychotics and summarize the results from published trials in order to evaluate the efficacy and potential benefits of atypical antipsychotics for the treatment of delirium in the elderly population. ⋯ A review of current literature supports the conclusion that atypical antipsychotic medications demonstrate similar rates of efficacy as haloperidol for the treatment of delirium in the elderly patient, with a lower rate of extrapyramidal side effects. There is limited evidence of true efficacy, since no double-blind placebo trials exist.
-
Anticachexic or antisarcopenic medications are prescribed worldwide for geriatric patients with poor appetite and associated weight loss. They represent a valuable treatment option for managing cachexia. However, the well-publicized adverse reports about these medications in acquired immunodeficiency syndrome (AIDS) and in the cancer population has led to some concern and much subsequent discussion over the safety of these medications being used in geriatric population. This review looks at the evidence in relation to the benefits and risks of these medications and discusses what we know about their use in the geriatric population.
-
Delirium is a classic geriatric syndrome that occurs commonly among the frail elders who make up many of the residents in postacute and long-term care facilities. The prevalence of the disorder in these settings may be increasing as a result of the pressure to reduce hospital length of stay. Clinicians often do not recognize when patients in their care are delirious, but simple and practical means exist to allow its diagnosis. Those who practice in long-term care must be knowledgeable about the risk factors for the disorder, as well as how to recognize, diagnose, prevent, and treat it.