title: Management of delirium in critically ill older adults.
abstract: Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients' family members.
authors.affiliation: University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA. mbalas@unmc.edu
authors.forename: Michele C
authors.initials: MC
authors.lastname: Balas
authors.forename: Michael
authors.initials: M
authors.lastname: Rice
authors.forename: Claudia
authors.initials: C
authors.lastname: Chaperon
authors.forename: Heather
authors.initials: H
authors.lastname: Smith
authors.forename: Maureen
authors.initials: M
authors.lastname: Disbot
authors.forename: Barry
authors.initials: B
authors.lastname: Fuchs
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D016638:Critical Illness / Q000451:nursing*; D003693:Delirium / Q000451:nursing* / Q000517:prevention & control*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007362:Intensive Care Units; D008875:Middle Aged; D024802:Nurse's Role; D009730:Nursing Assessment; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives