Cited by 926Intensive Care Unit Cognitive DisordersDementia and Cognitive Impairment ResearchAlcoholism and Thiamine Deficiency

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Delirium in Older Persons: Advances in Diagnosis and Treatment

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Oh, Esther S., Fong, Tamara G., Hshieh, Tammy T., Inouye, Sharon K.·2017·JAMA

DOI 10.1001/jama.2017.12067PMC PMC5717753

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Abstract

Importance: Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effects with substantial health care costs. Objective: To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field. Evidence Review: Search of Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011, until March 16, 2017, using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded. Findings: Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment; 4 A's Test; and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies. Conclusions and Relevance: Advances in diagnosis can improve recognition and risk stratification of delirium. Prevention of delirium using nonpharmacologic approaches is documented to be effective, while pharmacologic prevention and treatment of delirium remains controversial.

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Authors: Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K.
Affiliations: Johns Hopkins University (US)
Beth Israel Deaconess Medical Center (US)
Brigham and Women's Hospital (US)
ORCID: Oh, Esther S.
Fong, Tamara G.
Hshieh, Tammy T.
Inouye, Sharon K.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2017-09-26
Volume: 318
Issue: 12
Pages: 1161
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2017.12067
PMC: PMC5717753
OpenAlex: W2759229677
Cited by: 926
References: 116
Citations by year: 2026: 88 · 2025: 113 · 2024: 90 · 2023: 103 · 2022: 163 · 2021: 139 · 2020: 90 · 2019: 82 · 2018: 53 · 2017: 1
FWCI: 58.11
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR001102)
National Institute on Aging (P01AG031720, K07AG041835, P50AG005146, R24AG054259, R01AG044518, K23AG043504)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
Keywords: delirium, older adults, delirium diagnosis, delirium screening tools, Confusion Assessment Method, delirium severity assessment, delirium prevention, non-pharmacological treatment, immobility, antipsychotic drugs, sedating medications, delirium management, risk stratification
MeSH terms: Emergence Delirium, Aged, Delirium, Electroencephalography, Humans, Severity of Illness Index, Antipsychotic Agents, Biomarkers, Geriatric Assessment, Practice Guidelines as Topic

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