TAILIEUCHUNG - Chapter 026. Confusion and Delirium (Part 2)

Epidemiology Delirium is a common disease, but its reported incidence has varied widely based on the criteria used to define the disorder. Estimates of delirium in hospitalized patients range from 14 to 56%, with higher rates reported for elderly patients and patients undergoing hip surgery. Older patients in the ICU have especially high rates of delirium ranging from 70 to 87%. The condition is not recognized in up to one-third of delirious inpatients, and the diagnosis is especially problematic in the ICU environment where cognitive dysfunction is often difficult to appreciate in the setting of serious systemic illness and sedation | Chapter 026. Confusion and Delirium Part 2 Epidemiology Delirium is a common disease but its reported incidence has varied widely based on the criteria used to define the disorder. Estimates of delirium in hospitalized patients range from 14 to 56 with higher rates reported for elderly patients and patients undergoing hip surgery. Older patients in the ICU have especially high rates of delirium ranging from 70 to 87 . The condition is not recognized in up to one-third of delirious inpatients and the diagnosis is especially problematic in the ICU environment where cognitive dysfunction is often difficult to appreciate in the setting of serious systemic illness and sedation. Delirium in the ICU should be viewed as an important manifestation of organ dysfunction not unlike liver kidney or heart failure. Outside of the acute hospital setting delirium occurs in nearly two-thirds of patients in nursing homes and in over 80 of those at the end of life. These estimates emphasize the remarkably high frequency of this cognitive syndrome in older patients a population expected to grow in the upcoming decade with the aging of the baby boom generation. In previous decades an episode of delirium was viewed as a transient condition that carried a benign prognosis. Delirium has now been clearly associated with substantial morbidity and increased mortality and is increasingly recognized as a sign of serious underlying illness. Recent estimates of in-hospital mortality among delirious patients have ranged from 25 to 33 a rate that is similar to patients with sepsis. Patients with an in-hospital episode of delirium have a higher mortality in the months and years following their illness compared with age-matched nondelirious hospitalized patients. Delirious hospitalized patients have a longer length of stay are more likely to be discharged to a nursing home and are more likely to experience subsequent episodes of delirium as a result this condition has enormous economic implications.

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