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End of Life Care in Frailty: Delirium End of Life Care in Frailty: Delirium | British Geriatrics Society Toggle main menu visibility Search Search Search Resources (menu position rule) Date Published: 12 May 2020 Last updated: 12 February 2020 The aim of this guidance series is to support clinicians and others to consider the needs of frail older people as they move towards the end of their lives and help them to provide high quality care. This chapter examines the identification and management (...) of delirium in older people at the end of life. Please to view the other chapters in this series. Delirium – ‘acute confusion’ - is important to consider at the end of life. It may be almost universal in non-sudden death, especially in those with . Delirium has a poor prognosis, regardless of how well it is identified, investigated and treated, especially the hypoactive (drowsy) form. Half of those with delirium on general and geriatric medical wards will die within six months. It is important to be aware
COVID-19: Managing delirium in confirmed and suspected cases Coronavirus: Managing delirium in confirmed and suspected cases | British Geriatrics Society Toggle main menu visibility Search Search Search Coronavirus: Managing delirium in confirmed and suspected cases Topics: , Date Published: 19 March 2020 Last updated: 25 March 2020 Some of our members have been alerted to some difficulty in managing patients with delirium testing positive with COVID-19. This consensus advice has been drawn up (...) by experts from the organisations listed above. It should be used in conjunction with local policy and governance practice employed within your own organisation. Delirium, the clinical expression of encephalopathy, is important in the context of COVID-19, because (a) delirium may be a symptom at presentation and/or during management, and (b) the behavioural changes commonly seen in delirium, particularly agitation, may make management including delivery of care and reducing the risk of cross-infection
Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients.to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients.a (...) prospective observational multicenter cohort study.four Quebec EDs.independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation.eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium
Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults: A Randomized Clinical Trial Postoperative delirium (POD) is a common condition for older adults, contributing to their functional decline.To investigate the effectiveness of the Tailored, Family-Involved Hospital Elder Life Program (t-HELP) for preventing POD and functional decline in older patients after a noncardiac surgical procedure.A 2-arm, parallel-group, single (...) . Secondary outcomes included the pattern of functional and cognitive changes (activities of daily living [ADLs], instrumental activities of daily living [IADLs], Short Portable Mental Status Questionnaire [SPMSQ]) from hospital admission to 30 days after discharge, and the length of hospital stay (LOS).Of the 475 patients screened for eligibility, 281 (171 [60.9%] male, mean [SD] age 74.7 [5.2] years) were enrolled and randomized to receive t-HELP (n = 152) or usual care (n = 129). Postoperative delirium
The Healthy Heart-Mind Trial: Randomized Controlled Trial of Melatonin for Prevention of DeliriumDelirium is a serious medical condition with increased incidence in at-risk surgical populations. We sought to determine if melatonin use reduces the incidence of delirium in individuals undergoing major cardiac surgery.Randomized double-blind placebo-controlled clinical trial (two arms, 1:1 allocation, parallel design).The trial took place in two metropolitan hospitals (public tertiary and private (...) ) in Perth, Western Australia.We recruited 210 adults aged 50 years or older who were due to undergo coronary artery bypass grafting or valve replacement surgery.Participants were randomly assigned (1:1) to 7 days of treatment with melatonin 3 mg at night or matching placebo, starting 2 days before the surgery.The primary outcome of interest was incident delirium within 7 days of surgery as assessed via daily clinical assessment that included the Confusion Assessment Method. Secondary outcomes
Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines | CADTH.ca Find the information you need Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review of Evidence-Based Guidelines Fall Prevention Guidelines for Patients in Wheelchairs or Patients with Delirium: A Review (...) of Evidence-Based Guidelines Last updated: July 19, 2019 Project Number: RC1159-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What are the evidence based guidelines to prevent falls for older adults requiring wheelchairs in institutionalized care? What are the evidence based guidelines to prevent falls for adult patients with delirium in institutionalized care? Key Message One evidence-based guideline was included
Pharmacological interventions for the treatment of delirium in critically ill adults. Although delirium is typically an acute reversible cognitive impairment, its presence is associated with devastating impact on both short-term and long-term outcomes for critically ill patients. Advances in our understanding of the negative impact of delirium on patient outcomes have prompted trials evaluating multiple pharmacological interventions. However, considerable uncertainty surrounds the relative (...) benefits and safety of available pharmacological interventions for this population.Primary objective1. To assess the effects of pharmacological interventions for treatment of delirium on duration of delirium in critically ill adults with confirmed or documented high risk of deliriumSecondary objectivesTo assess the following:1. effects of pharmacological interventions on delirium-free and coma-free days; days with coma; delirium relapse; duration of mechanical ventilation; intensive care unit (ICU
Antipsychotics for the Prevention and Treatment of Delirium Antipsychotics for the Prevention and Treatment of Delirium Comparative Effectiveness Review Number 219 RComparative Effectiveness Review Number 219 Antipsychotics for the Prevention and Treatment of Delirium Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-00006-I, 290-32008-T Prepared by: Johns Hopkins (...) of delirium among adult patients. Key Messages • Haloperidol or second-generation antipsychotics used to prevent or treat delirium did not decrease length of stay in hospital. • There was little or no evidence to determine the effect of antipsychotics on cognitive function, delirium severity, or caregiver burden, or for sedation when used for prevention. • Second-generation antipsychotics may lower the occurrence of delirium in postoperative patients. • Haloperidol or second-generation antipsychotics used
External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment To externally validate two delirium prediction models (early prediction model for ICU delirium and recalibrated prediction model for ICU delirium) using either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for delirium assessment.Prospective (...) , multinational cohort study.Eleven ICUs from seven countries in three continents.Consecutive, delirium-free adults admitted to the ICU for greater than or equal to 6 hours in whom delirium could be reliably assessed.None.The predictors included in each model were collected at the time of ICU admission (early prediction model for ICU delirium) or within 24 hours of ICU admission (recalibrated prediction model for ICU delirium). Delirium was assessed using the Confusion Assessment Method-ICU or the Intensive
Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial. The effects of intensive care unit (ICU) visiting hours remain uncertain.To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium.Cluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants (...) were recruited from April 2017 to June 2018, with follow-up until July 2018.Flexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation.Primary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU
Effect of Targeting Mean Arterial Pressure During Cardiopulmonary Bypass by Monitoring Cerebral Autoregulation on Postsurgical Delirium Among Older Patients: A Nested Randomized Clinical Trial Delirium occurs in up to 52% of patients after cardiac surgery and may result from changes in cerebral perfusion. Using intraoperative cerebral autoregulation monitoring to individualize and optimize cerebral perfusion may be a useful strategy to reduce the incidence of delirium after cardiac surgery.To (...) determine whether targeting mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral autoregulation monitoring reduces the incidence of delirium compared with usual care.This randomized clinical trial nested within a larger trial enrolled patients older than 55 years who underwent nonemergency cardiac surgery at a single US academic medical center between October 11, 2012, and May 10, 2016, and had a high risk for neurologic complications. Patients, physicians, and outcome assessors
Intraoperative use of dexmedetomidine for the prevention of emergence agitation and postoperative delirium in thoracic surgery: a randomized-controlled trial We investigated whether preventive use of dexmedetomidine during surgery was effective for reducing emergence agitation and postoperative delirium.In this double-blind randomized-controlled trial, 143 patients undergoing thoracoscopic lung resection surgery were randomly assigned to the dexmedetomidine-sevoflurane (DEX-Sevo, n = 73 (...) ) or sevoflurane (Sevo, n = 70) groups. Dexmedetomidine or saline administration was started after inducing anesthesia and continued until the end of surgery at a fixed dose (0.5 µg·kg-1·hr-1). The primary endpoint was the incidence of delirium up until the end of postoperative day 3. Emergence agitation and postoperative delirium were measured with the Riker sedation agitation scale and the confusion assessment method, respectively. The secondary endpoints were serum cytokine and catecholamine levels.The DEX
Risk reduction and management of delirium Risk reduction and management of delirium A national clinical guideline March 2019 SIGN157Key to evidence statements and recommendations Levels of evidence 1 ++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 – Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2 ++ High-quality systematic reviews of case (...) term is valid until 31 March 2020 and is applicable to guidance produced using the processes described in SIGN 50: a guideline developer’s handbook, 2015 edition (www.sign.ac.uk/assets/sign50_2015.pdf). More information on accreditation can be viewed at www.nice.org.uk/accreditationRisk reduction and management of delirium A national clinical guideline March 2019 Scottish Intercollegiate Guidelines NetworkScottish Intercollegiate Guidelines Network Gyle Square, 1 South Gyle Crescent Edinburgh EH12
Pharmacological Management of Delirium in the Intensive Care Unit: A Randomized Pragmatic Clinical Trial Delirium in the intensive care units (ICUs) is prevalent, with both delirium duration and delirium severity associated with adverse outcomes. We designed a pragmatic trial to test the efficacy of a pharmacological management of delirium (PMD) bundle in improving delirium/coma-free days and reducing delirium severity among ICU patients.A randomized pragmatic clinical trial.Medical, surgical (...) , and progressive ICUs of three tertiary care hospitals.A total of 351 critically ill patients.A multicomponent PMD bundle consisting of reducing the exposure to 20 definite anticholinergic medications and benzodiazepines and prescribing low-dose haloperidol.The primary outcomes were delirium/coma-free days, measured through the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU (CAM-ICU), and delirium severity, measured through Delirium Rating Scale-Revised-98 and the CAM-ICU-7
Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. Postoperative delirium is common following cardiac surgery and may be affected by choice of analgesic and sedative.To evaluate the effect of postoperative intravenous (IV) acetaminophen (paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on postoperative delirium among older (...) with dexmedetomidine or propofol starting at chest closure and continued for up to 6 hours (acetaminophen and dexmedetomidine: n = 29; placebo and dexmedetomidine: n = 30; acetaminophen and propofol: n = 31; placebo and propofol: n = 30).The primary outcome was incidence of postoperative in-hospital delirium by the Confusion Assessment Method. Secondary outcomes included delirium duration, cognitive decline, breakthrough analgesia within the first 48 hours, and ICU and hospital length of stay.Among 121 patients
Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.Randomized clinical trial of 1232 adults aged 60 years (...) and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures