Rachel O'Mahony, PhD; Lakshmi Murthy, MSc; Anayo Akunne, PhD, MPH; John Young, MB BS, MSc; for the Guideline Development Group
Delirium is common, is often underrecognized, and is associated with poor outcomes and high costs. In July 2010, the National Institute for Health and Clinical Excellence released a guideline that addressed diagnosis, prevention, and management of delirium. This synopsis focuses on the main recommendations about prevention of delirium.
The National Clinical Guideline Centre developed these guidelines by using standard methodology of the National Institute for Health and Clinical Excellence. A multidisciplinary guideline development group posed review questions, discussed evidence, and formulated the recommendations. To underpin the guideline, a technical team from the National Clinical Guideline Centre systematically reviewed and graded pertinent evidence identified from literature searches of studies published in English to August 2009 and performed health economic modeling. Stakeholder and public comment informed guideline development and modifications.
Considering prevention a feasible and cost-effective health strategy, the guideline development group made 13 specific recommendations that addressed the stability of the care environment (both the care team and location) and the provision of a multicomponent intervention package tailored for persons at risk for delirium. The multicomponent intervention package included assessment and modification of key clinical factors that may precipitate delirium, including cognitive impairment or disorientation, dehydration or constipation, hypoxia, infection, immobility or limited mobility, several medications, pain, poor nutrition, sensory impairment, and sleep disturbance.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Mark A. LaPorta
Mark Antony LaPorta MD FACP, Roseland FL
June 13, 2011
Excellence in Delerium
With the understanding that I could have missed a citation,
I was disappointed not to have seen adequate reference to the current problem -- at any age -- of alcohol, illegal or illicit drug use, or surreptious abuse of prescriptions in patients who will not admit it -- or be able to.And I did not see any reference in this article to acute withdrawal from same, which can take place and prolonged intervals from substance cessation.
These are empirically extremely important and underappreciated causative and confounding factors.
On the other hand it was a good review of pathophysiologic states, even mild ones, that can induce altered mental status through a variety of processes. The brown-bag session cannot be repeated too often.
Last question: only slightly facetious: Are not many people in a state of "subsyndromal delerium" as they go about their daily affairs?
Not in the usual sense!
O'Mahony R, Murthy L, Akunne A, Young J, for the Guideline Development Group. Synopsis of the National Institute for Health and Clinical Excellence Guideline for Prevention of Delirium. Ann Intern Med. 2011;154:746–751. doi: 10.7326/0003-4819-154-11-201106070-00006
Download citation file:
Published: Ann Intern Med. 2011;154(11):746-751.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only