This article will cover the definition and symptoms of delirium and its subtypes, how it is assessed and diagnosed, and its non-pharmacological and pharmacological management. Pharmacists in all settings should be aware of delirium because it is a serious condition that often signals an underlying illness or medication issue, which requires prompt intervention. Pharmacists also have a crucial role in prevention strategies and managing medicine-related risk. The pathophysiology of delirium is poorly understood and there is no single aetiology.
In both the primary and secondary care setting, older people aged 65 years or older are more susceptible to delirium, as age and pre-existing cognitive impairment are important predisposing risk factors. It is also likely that this cohort of patients will have a greater number of other risk factors associated with delirium and so particular care needs to be taken. Depending on the type of risk factors identified, an individualised approach is needed to manage them. Steps to minimise risk may include: regular medication review; managing medical conditions e.
The quick onset of delirium and fluctuating course often distinguishes it from dementia and depression, where there is a more gradual onset over months and years. Most people with delirium will require a hospital admission for urgent assessment, investigation and management of precipitating factors.
Management in primary care may be appropriate if:. Delirium is a clinical diagnosis; a detailed history and clinical examination are much more helpful at making a diagnosis rather than a single test or combination of investigations. It is also important to identify and manage any precipitating factors, as per Table 1. The DSM-5 criteria for delirium can be used to inform diagnosis, see Box. Disturbance in attention i. The disturbance develops over a short period of time usually hours to a few days , represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during a day;.
An additional disturbance in cognition, such as memory deficit, disorientation, language, visuospatial ability or perception;.
