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Medication Causes of Delirium in the Elderly

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1. Australian and New Zealand Society for Geriatric Medicine position statement 13. Delirium in older people

usage. J Am Geriatr Soc 2008;56:823-30. 47. Tropea J, Slee JA, Brand CA, Gray L, Snell T. Clinical practice guidelines for the management of delirium in older people in Australia. Australas J Ageing 2008;27:150-6. 48. O'Keeffe ST, Lavan JN. Subcutaneous fluids in elderly hospital patients with cognitive impairment. Gerontology 1996;42:36-9. 49. Pitkala KH, Laurila JV, Strandberg TE, Kautiainen H, Sintonen H, Tilvis RS. Multicomponent geriatric intervention for elderly inpatients with delirium (...) -7. 62. Setoguchi S, Wang PS, Alan Brookhart M, Canning CF, Kaci L, Schneeweiss S. Potential causes of higher mortality in elderly users of conventional and atypical antipsychotic medications. J Am Geriatr Soc 2008;56:1644-50. 63. Knol W, van Marum RJ, Jansen PA, Souverein PC, Schobben AF, Egberts AC. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc 2008;56:661-6. 64. Huybrechts KF, Gerhard T, Crystal S, et al. Differential risk of death in older residents

2012 Clinical Practice Guidelines Portal

2. Top 5 Things I’ve Learned About Geriatric Emergency Medicine

of older people. Age Ageing . 2016;45(5):703-707. [ ] 16. Rosen T, Hargarten S, Flomenbaum N, Platts-Mills T. Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach. Ann Emerg Med . 2016;68(3):378-382. [ ] 17. Anglin D, Homeier D. Elder abuse and neglect. In: Marx J, Hockberger R, eds. Rosen’s Emergency Medicine . Elsevier/Saunders; 2014:885-892. 18. Acute functional decline. Geri-EM. . Published 2013. Accessed July 21, 2017. 19. The geriatrics (...) Top 5 Things I’ve Learned About Geriatric Emergency Medicine Top 5 Things I've Learned About Geriatric Emergency Medicine - CanadiEM Top 5 Things I’ve Learned About Geriatric Emergency Medicine In by Thom Ringer August 1, 2017 My medical school dean urged our class to “think not just about what interests you, but about who needs you.” Few patients I’ve encountered in healthcare have struck me as more in need than the frail elderly. As I’ve learned, the ED lies at the heart of the elder care

2017 CandiEM

3. Delirium in the elderly: current problems with increasing geriatric age Full Text available with Trip Pro

Delirium in the elderly: current problems with increasing geriatric age Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline (...) further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multifactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age.

2015 The Indian journal of medical research

4. Australian and New Zealand Society for Geriatric Medicine position statement 22. Frailty in older people

in the interpretation of clinical studies involving older persons. Arch Intern Med. 2010;170(7):587-95. 59. Eeles EMP, White SV, O’Mahony MS, Bayer AJ, Hubbard RE. The Impact of Frailty and Delirium on Mortality in Older Inpatients. Age and Ageing. In press 60. Berthold HK, Gouni-Berthold I. Lipid-lowering drug therapy in elderly patients. Curr Pharm Des 2011; 17: 877-93. 61. Hines LE, Murphy JE. Potentially harmful drug-drug interactions in the elderly: a review. Am J Geriatr Pharmacother. 2011;9(6):364- 77. 62 (...) : Dr Ruth Hubbard and Dr Kenneth Ng BACKGROUND The care of older people is becoming a core remit of acute hospitals in Australia and New Zealand. In 2005– 06, while comprising only 13.2 per cent of Australia’s population, those aged 65 years or over represented 35 per cent of all hospital admissions and 47 per cent of all occupied bed days 1 . Older, complex patients with multidisciplinary needs are not confined to Geriatric Medicine units but are scattered throughout general medical wards 2

2014 Clinical Practice Guidelines Portal

5. Interventions for preventing delirium in older people in institutional long-term care. (Abstract)

Interventions for preventing delirium in older people in institutional long-term care. Delirium is a common and distressing mental disorder. It is often caused by a combination of stressor events in susceptible people, particularly older people living with frailty and dementia. Adults living in institutional long-term care (LTC) are at particularly high risk of delirium. An episode of delirium increases risks of admission to hospital, development or worsening of dementia and death (...) ) of single and multicomponent, non-pharmacological and pharmacological interventions for preventing delirium in older people (aged 65 years and over) in permanent LTC residence.We used standard methodological procedures expected by Cochrane. Primary outcomes were prevalence, incidence and severity of delirium; and mortality. Secondary outcomes included falls, hospital admissions and other adverse events; cognitive function; new diagnoses of dementia; activities of daily living; quality of life; and cost

2019 Cochrane

6. CRACKCast E181 – Approach to the Geriatric Patient

day? (yes) Each “yes” response counts as 1 point, for a total score ranging from 0 to 6. A patient is considered at high risk when the score is 2 or more. Adapted from McCusker J, Bellavance F, Cardin S, et al: Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 47:1229–1237, 1999. bCAM Assessment (Brief Confusion Assessment Method) Figure 183.2 Need both of: Acute altered mental status or fluctuating course (...) Transportation Medication management Ability to handle finances [2] List 6 factors that lead to altered pharmacokinetics in the elderly. Altered GI motility and perfusion (blood flow) Decreased hepatic function Decreased renal function Decreased lean body mass Increased adipose tissue Changes in protein binding [3] List reason why the elderly are predisposed to adverse drug reactions. Polypharmacy / drug interactions Comorbidites All of the pharmacokinetic reasons: Altered GI motility and perfusion (blood

2018 CandiEM

7. Medication Causes of Delirium in the Elderly

Administration 4 Medication Causes of Delirium in the Elderly Medication Causes of Delirium in the Elderly Aka: Medication Causes of Delirium in the Elderly , Drug-Induced Delirium in Older Adults , Altered Mental Status due to Medications in Geriatric Patients II. Causes See s s (e.g. , ) s (e.g. , , , ) s ( , ) s (e.g. , , meclizine) Medications ( s, ) s (e.g. , ) s (e.g. , , ) Muscle relaxants (e.g. , , carisprodol) s III. References Khoujah and Magidson (2016) Crit Dec Emerg Med 30(10): 3-10 Images (...) Medication Causes of Delirium in the Elderly Medication Causes of Delirium in the Elderly Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2018 FP Notebook

8. Multicomponent Interventions Reduce High-Risk Medications for Delirium in Hospitalized Older Adults. (Abstract)

Multicomponent Interventions Reduce High-Risk Medications for Delirium in Hospitalized Older Adults. Delirium threatens the functional independence and cognitive capacity of patients. Medications, especially those with strong anticholinergic effects, have been implicated as a preventable cause of delirium. We evaluated the effect of multicomponent interventions aimed at reducing the use of 9 target medications in hospitalized older adults at risk of delirium. This continuous quality improvement (...) . Multicomponent interventions implemented in our hospital system were effective at reducing exposure to target medications in hospitalized older adults at risk of delirium. These systematic changes applied throughout the medication use process are sustained today.© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

2018 Journal of the American Geriatrics Society

9. Under-detection of delirium and impact of neurocognitive deficits on in-hospital mortality among acute geriatric and medical wards. (Abstract)

Under-detection of delirium and impact of neurocognitive deficits on in-hospital mortality among acute geriatric and medical wards. Delirium is a neuropsychiatric disorder, triggered by medical precipitants causes. Study aims were to describe the prevalence and impact on in-hospital mortality of delirium identified through ICD-9 codes as well as evidence of neurocognitive deficits demonstrated in a population of older patients admitted to acute medical wards.This was a prospective cohort (...) for covariates.The documentation of delirium is poor in medical wards of Italian acute hospitals. Neurocognitive deficits on objective testing (in a pattern suggestive of undiagnosed delirium) should be used to raise awareness of delirium, given their association with in-hospital mortality.Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

2015 European journal of internal medicine

10. Improving Quality of Life: Substance Use and Aging

services. This chapter provides an overview of some of the harmful consequences of substance use among the aging population, including hospitalization, falls, vehicular accidents, cognitive impairment, depression, substance withdrawal and death, including by suicide. Mortality rates are much higher among older adults who have substance use disorders. Because the use of alcohol and medication, whether prescribed or misused, causes greater harm in older adults than illicit drugs, this chapter focuses (...) use, as we do in this report, is key to developing new and more tailored strategies for reducing the harms of alcohol and drugs on older adults. Since 2005, the series now known as Substance Use in Canada has highlighted alcohol- and drug-related issues that are in need of greater attention. For this seventh edition, we began with two questions: How can we help people age in a healthy way? and How can we ensure they have the supports they need to sustain a good quality of life in their later years

2018 Canadian Centre on Substance Abuse

11. Abnormal Mini-Cog Is Associated with Higher Risk of Complications and Delirium in Geriatric Patients with Fracture (Abstract)

Abnormal Mini-Cog Is Associated with Higher Risk of Complications and Delirium in Geriatric Patients with Fracture The Mini-Cog test is a validated and simple tool to screen for dementia. The purpose of this study was to investigate the relationship of cognitive impairment as measured by Mini-Cog testing as a predictor for in-hospital complications and mortality in geriatric patients with fracture.From 2011 to 2014, patients who were seventy years of age or older, had a fracture, and were (...) age, eighty-three years) attempted Mini-Cog testing. Of those, 513 were able to complete the test, demonstrating a 35.1% prevalence of cognitive impairment. The cohort's rate of in-hospital medical complications was 28.6%. Patients with an abnormal Mini-Cog test or those unable to complete the test had significantly higher odds of in-hospital complications (2.16 and 2.27, respectively) compared with patients with a normal Mini-Cog test (p < 0.001). Delirium was significantly increased in patients

2016 EvidenceUpdates

12. Risk Evaluation of Postoperative Delirium Using Comprehensive Geriatric Assessment in Elderly Patients with Esophageal Cancer. (Abstract)

Risk Evaluation of Postoperative Delirium Using Comprehensive Geriatric Assessment in Elderly Patients with Esophageal Cancer. The number of geriatric patients with esophageal cancer is increasing in step with the aging of the population. Geriatric patients have a higher risk of postoperative complications, including delirium that can cause a fall or impact survival. Therefore, it is very important that we evaluate risks of postoperative complications before surgery. The aim of this study (...) was to predict postoperative delirium in elderly patients.We retrospectively reviewed the medical records of 91 patients aged 75 years and over who underwent esophagectomy between January 2006 and December 2014. We investigated the association between postoperative delirium and clinicopathological factors, including comprehensive geriatric assessment (CGA).Postoperative delirium developed in 24 (26 %) patients. Postoperative delirium was significantly associated with low mini-mental state examination (MMSE

2016 World Journal of Surgery

13. Early Geriatric Follow-up in Older Acute Medical Patients

: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Health Services Research Official Title: Early Geriatric Follow-up After Hospital Discharge in Older Acute Medical Patients - a Quasi Randomized Controlled Trial Study Start Date : June 2014 Actual Primary Completion Date : November 2016 Actual Study Completion Date : November 2016 Resource links provided by the National Library of Medicine related topics: Arms and Interventions Go to Arm Intervention/treatment (...) Early Geriatric Follow-up in Older Acute Medical Patients Early Geriatric Follow-up in Older Acute Medical Patients - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Early Geriatric Follow-up in Older Acute

2015 Clinical Trials

14. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

, costly medical conditions, and new health care technologies and strategies. The National Institute on Aging of the National Institutes of Health requested this report from the AHRQ Evidence-based Practice Center (EPC) Program. The report was presented October 25, 2016, at the National Academies of Sciences, Engineering, and Medicine public meeting Preventing Dementia and Cognitive Impairment: A Workshop. The reports and assessments provide organizations with comprehensive, evidence-based information (...) Edition (DSM-5). 10 Roughly half of people with MCI will progress to a more severe form of cognitive decline over about 3 years. 11 A separate Institute of Medicine committee (not connected with this study) recently recognized that using a history of functional decline to distinguish between MCI and dementia is a problem, 7 because the presence of functional impairment depends on social factors independent of the underlying disease causing cognitive impairment. Recognizing and measuring cognitive

2017 Effective Health Care Program (AHRQ)

15. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

, costly medical conditions, and new health care technologies and strategies. The National Institute on Aging of the National Institutes of Health requested this report from the AHRQ Evidence-based Practice Center (EPC) Program. The report was presented October 25, 2016, at the National Academies of Sciences, Engineering, and Medicine public meeting Preventing Dementia and Cognitive Impairment: A Workshop. The reports and assessments provide organizations with comprehensive, evidence-based information (...) Edition (DSM-5). 10 Roughly half of people with MCI will progress to a more severe form of cognitive decline over about 3 years. 11 A separate Institute of Medicine committee (not connected with this study) recently recognized that using a history of functional decline to distinguish between MCI and dementia is a problem, 7 because the presence of functional impairment depends on social factors independent of the underlying disease causing cognitive impairment. Recognizing and measuring cognitive

2017 Effective Health Care Program (AHRQ)

16. TIME to think about delirium: improving detection and management on the acute medical unit Full Text available with Trip Pro

and improve management of delirium on the acute medical unit (AMU). We reviewed whether a delirium screening tool (4AT) had been completed for all patients aged over 65 years admitted to the AMU over 1 week. If delirium was detected, we assessed whether investigation and management was adequate as per national guidance. After baseline data collection, we delivered focused sessions of delirium education for doctors and nursing staff, including training on use of the 4AT tool and the TIME (Triggers (...) TIME to think about delirium: improving detection and management on the acute medical unit Delirium affects 18%-35% patients in the acute hospital setting, yet is often neither detected nor managed appropriately. It is associated with increased risk of falls, longer hospital stay and increased morbidity and mortality rates. It is a frightening and unpleasant experience for both patients and their families. We used quality improvement tools and a multicomponent intervention to promote detection

2018 BMJ Open Quality

17. Prevention of Dehydration in Geriatric Patients in Long-Term Care

: Recognition: Step 1 (Tables 1 & 2), Step 2 Assessment: Steps 3-6 Monitoring and Prevention: Steps 9 and 10 PREPARED BY: Canadian Agency for Drugs and Technologies in Health Tel: 1-866-898-8439 www.cadth.ca Prevention of Dehydration in Geriatric Patients in Long-Term Care 3 APPENDIX – FURTHER INFORMATION: Systematic Reviews and Meta-analyses – Setting Not Specified 5. Hodgkinson B, Evans D, Wood J. Maintaining oral hydration in older adults: a systematic review. Int J Nurs Pract. 2003 Jun;9(3):S19-S28 (...) [Internet]. 4th ed. New York (NY): Springer Publishing Company; 2012. p. 419-38. http://consultgerirn.org/topics/hydration_management/want_to_know_more See: Nursing Care Strategies, A. Risk identification, no. 2 Summary available from: http://www.guideline.gov/content.aspx?id=43929 2. Smith CM, Cotter V. Age-related changes in health. In: Boltz M, Capezuti E, Fulmer T, Zwicker D, editors. Evidence-based geriatric nursing protocols for best practice [Internet]. 4th ed. New York (NY): Springer Publishing

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

18. Models of community care for the elderly involving collaboration between specialized geriatric services and primary care practitioners

is considered essential in order to facilitate routine monitoring and treatment of health problems that may impact cognitive function. Program name: Diagnostic Observation Centre for Psychogeriatric Patients (DOC-PG) Key components: Out-patient diagnostic facility; aim to provide PCP with detailed diagnostic and therapeutic advice for patients with cognitive disorders. Expertise in the old age psychiatry, geriatric medicine, neuropsychology, physiotherapy, occupational therapy, geriatric nursing, and mental (...) based on their age, self- reported health and/or functional limitations Herbert et Canada (Quebec) 65+, to present significant disabilities, need al.(2010) RefID90 [Other reference: for >3 different Milette et services. al.(2005) RefID283 advance to join their members for PCP office visits. Program name: Co-management model; a primary care approach for direct care of vulnerable elders Key components: Referral of PCP to clinician (or clinician teams) with expertise in caring for the elderly

2011 OHRI Knowledge to Action

19. The Bundled Hospital Elder Life Program-HELP and HELP in Home Care-and Its Association With Clinical Outcomes Among Older Adults Discharged to Home Healthcare. (Abstract)

The Bundled Hospital Elder Life Program-HELP and HELP in Home Care-and Its Association With Clinical Outcomes Among Older Adults Discharged to Home Healthcare. To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30-day all-cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP.Matched case-control study.Two medical-surgical units within two midwestern (...) rural hospitals and patient homes (home health).Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non-Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching.The primary study outcome was 30-day all-cause

2019 Journal of the American Geriatrics Society

20. Ranitidine-Induced Delirium in a 7-Year-Old Girl: A Case Report. Full Text available with Trip Pro

Ranitidine-Induced Delirium in a 7-Year-Old Girl: A Case Report. Ranitidine is a histamine-2 blocker commonly prescribed in PICUs for the prophylaxis of gastrointestinal bleeding and stress ulcers. However, it can be associated to central nervous system side effects, such as delirium, in adults. We present the first case of a child presenting delirium possibly caused by anticholinergic toxidrome secondary to the use of ranitidine, resolving after drug discontinuation. With this case report, we (...) reinforce that a wide variety of clinical conditions can trigger delirium and that the best therapeutic approach is to minimize risk factors.Copyright © 2019 by the American Academy of Pediatrics.

2019 Pediatrics

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