Introduction
Advancing aging is often a matter of concern. As age advances, one becomes more vulnerable to certain medical conditions or illnesses. Age-related physiological changes in the body often reflect ailments or comorbidities. Delirium is a public health concern frequently reported among elderly adults. The development of delirium is influenced by multiple factors, which contribute to the intricate nature of the condition. More than a medical condition, it is identified as a mental state experienced by an individual. Identifying the correct cause behind delirium is critical for the strategic planning of therapeutic interventions, which is an integral determinant of the success of the treatment intervention. Often, this neuropsychiatric state is left unrecognized. This article emphasizes the diagnostic and preventive aspects of delirium.
What Is Delirium?
Delirium is a peculiar state of mind where the person loses cognitive skills (brain functions like memory, thinking, reasoning, decision-making, and intelligence) and cannot process thoughts. The cognitive decline associated with delirium is often sudden in onset. Because of its acute presentation, it was earlier regarded as an acute confusional state. It is an alarming state of mind with a broad spectrum of manifestations. Altered brain function is responsible for this condition. Delirium is often precipitated as an indication of certain underlying illnesses that otherwise would have been left undiagnosed.
Frequently reported manifestations associated with delirium in elderly adults include confusion, disorientation, restlessness, behavioral abnormalities, inability to focus, anxiety, altered alertness, hallucinations (unrealities), altered sleep patterns, hypervigilance (extreme alert), drowsiness, and compromised awareness of people, place, and things. However, in many instances, these are wrongly perceived as general memory loss (dementia) or other chronic conditions triggered by the aging process. Intricate factors like the presence of other ailments, long-term medications, neurological conditions, infections, surgical interventions, severe dehydration, and much more greatly influence delirium.
Delirium is often timely diagnosed in younger patients, but in elderly adults, it is either underdiagnosed or misdiagnosed, which delays medical intervention and influences the prognosis of the condition. It can bring out detrimental outcomes in elderly adults. Various study reports mentioned an enhanced morbidity and mortality associated with delirium in elderly adults. It occasionally necessitates hospital admission and, at times, even long-term hospitalization, which can be financially draining.
How Is Delirium in Elderly Adults Diagnosed?
Diagnosing delirium in elderly adults is quite challenging, as it can manifest differently, and mandates assistance with prompt medical history. Delirium diagnosis is more clinical, and the physician needs to evaluate the person thoroughly. Being a symptomatic condition, the physicians rely more on the clinical presentation and their assessment to arrive at the final diagnosis. However, the symptoms could be more specific and overlapping, often confusing in identifying the real cause and condition. The diagnostic process not only aims at figuring out the condition but also exposes the underlying etiological factors that trigger it, which is indispensable for the strategic planning of the therapeutic intervention. The diagnostic strategies employed for delirium in elderly adults include the following:
1. Patient’s Medical Background:
A patient’s medical history often gives an idea about their health status, which is critical in delirium diagnosis. Known risk factors like the presence of multiple comorbidities and multiple medications often give hints for the diagnosis.
2. Clinical Assessment:
In clinical assessment, the concerned doctors may look for signs of any ongoing illness or infection in the body, which could have potentially triggered delirium. A comprehensive assessment of the person’s health status is achieved through clinical examinations and evaluation.
3. Assessment of Cognitive and Mental Status:
A thorough discussion with the patient aids in assessing the person's mental state. The interview assesses the patient’s awareness, orientation, concentration, behavior, mood fluctuations, consciousness, and cognitive skills. In severely ill patients who cannot speak, alertness and attention are tested using auditory or visual stimuli. Behavioral evaluation is done by close observation of the patient. The patient may exhibit altered behavioral responses like restlessness, hypervigilance, and anxiety, which become evident during observation. The delirium rating scale (rate delirium based on symptom severity) and confusion assessment method (gold standard tool, which detects delirium by considering four critical parameters - inattention, impaired consciousness, sudden onset with the varying course of progression, and chaotic thinking) are the two routinely employed methods for cognitive assessment.
4. Neurological Assessment:
Neurological functional impairment and deficits are figured out during neurological assessment. The patient needs to be looked for signs like tremors (fine shaking of body parts), altered body posture and walking pattern, visual irregularities, balancing issues, and abnormal reflexes. Neurological assessment often aids in revealing any underlying medical conditions like stroke (obstructed brain blood flow) or subdural hematoma (blood gathering within the brain space) that could have possibly led to delirium.
5. Eliminating Possible Differential Diagnosis:
Delirium possesses specific overlapping symptoms with other elderly conditions like dementia, which create confusion during diagnosis. All the possibilities for other related conditions need to be ruled out before establishing the diagnosis of delirium. It can be achieved by closely inspecting the distinguishing parameters.
6. Brain Imaging Tests:
Brain imaging tests like Magnetic Resonance Imaging (MRI) are employed in cases where clinical and physical assessment strategies fail to establish the diagnosis. They are employed as the last resort for arriving at the final diagnosis.
What Are the Preventive Aspects of Delirium in Elderly Adults?
Prevention is a promising strategy to check the development of delirium in elderly adults, encompassing a multifaceted approach. As per the study reports, around 30 to 40 percent of delirium cases in elderly adults can be potentially prevented with appropriate preventive strategies. Preventive strategies include the following:
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Identifying Susceptible Patients: Vulnerable patients can be identified by assessing their known precipitants and risk factors. Modifying the drug choice and prompt treatment for underlying conditions are some of the preventive strategies. Periodic health checkups aid in keeping medical conditions under control. Certain medications like benzodiazepines are known triggers for delirium, and doctors may advise alternate choices as part of a preventive measure to check the development of delirium.
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Adequate Hydration: Dehydration can potentially trigger delirium; therefore, the risk of delirium can be diminished by keeping oneself adequately hydrated. Furthermore, a balanced diet with all the required nutrients in the right proportions also has preventive potential.
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Ensure Sufficient Sleep: Sleep deprivation can bring about stress, resulting in delirium. Therefore, ensure sufficient and sound sleep to keep oneself away from delirium.
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Mental and Physical Activity: Engaging in mental and physical activity keeps the mind and body healthy and active. It not only enhances mental acuity but also augments cognitive skills.
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Lifestyle Modification: Ensure a calm, peaceful, and stress-free environment for elderly adults, which keeps them active and happy. It is proven to be an effective preventive strategy for delirium.
Conclusion
Though delirium in elderly adults is considered to be an alarming condition, with effective preventive strategies, the incidence of delirium can be remarkably brought down. Proactive healthcare measures, lifestyle changes, increased awareness, and dietary modifications are preventive strategies that greatly reduce delirium cases among the geriatric population. A timely diagnosis is a critical determinant of the treatment outcome. A collaborative preventive approach helps susceptible patients enjoy their later ages easily and happily.
