title: Delirium in elderly people.
abstract: Delirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows that pharmacological prevention or treatment is effective. Drug reduction for sedation and analgesia and non-pharmacological approaches are recommended. Delirium offers opportunities to elucidate brain pathophysiology--it serves both as a marker of brain vulnerability with decreased reserve and as a potential mechanism for permanent cognitive damage. As a potent indicator of patients' safety, delirium provides a target for system-wide process improvements. Public health priorities include improvements in coding, reimbursement from insurers, and research funding, and widespread education for clinicians and the public about the importance of delirium.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Electronic address: agingbraincenter@hsl.harvard.edu.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.affiliation: Leiden University Medical Center, Leiden, Netherlands; Leyden Academy on Vitality and Ageing, Leiden, Netherlands.
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.affiliation: Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
mesh_terms: D000368:Aged; D035843:Biomedical Research / Q000379:methods; D003072:Cognition Disorders / Q000209:etiology; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D003704:Dementia / Q000209:etiology; D006801:Humans; D011379:Prognosis; D012307:Risk Factors