Don’t assume a diagnosis of dementia in an older adult who presents with an altered mental status and/or symptoms of confusion without assessing for delirium or delirium superimposed on dementia using a brief, sensitive, validated assessment tool.

Rationale and Comments

Delirium is common in older adults, especially in the hospital setting, yet delirium is frequently unrecognized and not documented by nursing or medical staff. Delirium occurs in as much as 50% of older adults in the hospital, and delirium superimposed on dementia occurs in as high as 90% of hospitalized older adults. Delirium is associated with very poor clinical outcomes, including prolonged length of stay, high costs and lower quality of life for older adults when not detected early. Delirium is treatable and often reversible and dementia is not, so mislabeling older adults with dementia may miss a life-threatening underlying condition causing the delirium such as an infection, medication side effect, or subdural hematoma. Delirium is extremely costly to the health care system and to society with estimates ranging from $143 to $152 billion annually. Nurses and physicians often fail to recognize delirium. Only 12% to 35% of delirium cases are detected in routine care, with hypoactive delirium and delirium superimposed on dementia most likely to be missed.

Sponsoring Organizations

American Academy of Nursing

Sources

Expert consensus

Disciplines

Geriatric Medicine
Psychiatric and Psychologic

References

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