Delirium, a multifactorial syndrome, is an acute confusional state marked by sudden onset, fluctuating course, inattention, and at times changing levels of consciousness. Risk for developing delirium depends on both predisposing conditions which increase susceptibility and the immediate precipitating factors. About one third of older adults experience delirium during hospitalizations on medical services; rates are even higher following major elective surgeries. Intensive care unit admissions are associated with a high incidence of delirium regardless of age. Even though delirium is associated with poor patient outcomes, more than 50% of cases are undetected.
The Confusional Assessment Method (CAM) algorithm, displayed below, is recommended for screening at-risk patients. The CAM instrument can quickly and accurately detect delirium at the bedside; a CAM severity (CAM-S) measure can be used to predict risks for death and nursing home placement. The National Institutes of Health (NIH) have issued guidelines for preventing delirium that emphasize multicomponent interventions by interdisciplinary teams targeting key clinical precipitants.
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