Physicians vary in approaches to the clinical management of delirium.
OBJECTIVE
To ascertain the variation in strategies for managing delirium of physicians with expertise in geriatrics.


METHODS
Cross-sectional mail survey.


METHODS
United States.


METHODS
A probability sample of physician members of the American Geriatrics Society.


METHODS
Management choices presented in a two-part case vignette of an older woman hospitalized with a hip fracture who develops mild and then severe delirium.


RESULTS
One hundred twenty-two respondents (43%) selected the three answers constituting current "best practice," 50 (18%) selected an unnecessary diagnostic test (brain imaging, lumbar puncture, or electroencephalogram), and 47 (17%) selected unnecessary pharmacologic therapy for mild delirium. For severe delirium, 270 (96%) selected pharmacological therapy, of whom 180 chose haloperidol alone, 55 chose lorazepam alone, 23 chose lorazepam in combination with haloperidol, and 12 wrote in another drug. Thirty percent of the respondents made any selection of lorazepam, alone or in combination with haloperidol, for mild or severe delirium. Sixty-one percent of those selecting haloperidol for severe delirium chose a dose greater than that recommended for geriatric patients. Sex, date of graduation from medical school, clinical specialty, completion of a geriatric fellowship, or certification in geriatrics had no significant effect on responses.


CONCLUSIONS
The common selection of lorazepam to treat delirium is troubling because benzodiazepines themselves are implicated in delirium. Selection of an initial dose of haloperidol higher than that recommended for geriatric patients by more than half of the respondents is also of concern. There is a paucity of sound clinical evidence to guide the choice of pharmacological agents for treating delirium in older hospitalized patients.
Carnes
Molly
M
Department of Medicine, Center for Women's Health and Women's Health Research, University of Wisconsin, Madison, Wisconsin 53715, USA.
Howell
Timothy
T
Rosenberg
Marjorie
M
Francis
Joseph
J
Hildebrand
Christopher
C
Knuppel
Jeffrey
J
D000368:Aged; D003430:Cross-Sectional Studies; D003693:Delirium / Q000628:therapy*; D006801:Humans; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires