Old people adult cams
A high index of suspicion can allow clinicians to recognize delirium promptly and search for the underlying cause. Workup includes a thorough history, physical examination, and investigations to identify acute illness or destabilized chronic conditions. This process is self-propelling and can last for months after the initial event. Anticholinergic medications are known to induce or worsen delirium by binding to nicotinic and muscarinic receptors in the brain, modulating cognition and arousal, and lending support to the concept of cholinergic deficiency in delirium. In addition, metabolic abnormalities may lead to decreased acetylcholine synthesis and synaptic transmission.
Delirium is common in the hospitalized older adult, with some studies reporting incidence rates of 29% to 64%. The consequences of delirium are significant and include associations with increased mortality, cognitive and functional decline, falls, and admission to long-term care. When delirium does occur, the medical team and patient’s family should be aware that further support on discharge may be needed given the risk of cognitive and functional decline associated with delirium.
Because a multitude of underlying causes may be involved, a broad diagnostic approach is needed and clinicians should keep an open mind about the possibility of more than one contributing medical problem.
The workup should include a detailed assessment to search for the precipitant, whether it is an acute medical illness, a change in therapy, or the destabilization of a chronic condition. 3D-CAM: Derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: A cross-sectional diagnostic test study.
For more information, call 311 and ask for the JASA case management program in Brooklyn.
The Senior Employment Services Unit trains older adults for jobs in today’s workforce.
A chest X-ray or urinalysis and culture should be considered if symptoms suggest infection, keeping in mind that elderly patients can fail to manifest typical signs of infection (elevated white blood cell count, fever, or focal symptoms).