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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• Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014 Mar 8;383(9920):911-22.
  
• Fick DM, Steis MR, Waller JL, Inouye SK. Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med. 2013 Sep;8(9):500-5.
  
• Steis MR, Fick DM. Delirium superimposed on dementia: accuracy of nurse documentation. J Gerontol Nurs. 2012 Jan;38(1):32-42.
  
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• Fick DM, Hodo DM, Lawrence F, Inouye SK. Recognizing delirium superimposed on dementia: assessing nurses’ knowledge using case vignettes. J Gerontol Nurs. 2007 Feb;33(2):40-7.