Deliriumis an epidemic among hospitalized adult patients, with an incidence of up to
64% in high risk populations such as patients in intensive care who are
ventilated and patients receiving anesthetics and sedation. It is one of the
most common neuro-psychiatric complications experienced by palliative care patients.
Patients predisposed to delirium tend to be ill, frail and/or elderly. Delirium
is generally the result of multiple contributory factors which are easily
recognized and potentially modifiable. Yet, symptoms are under recognized and
delirium is under-diagnosed, with up to 84% of physicians and 30% of nurses
missing the diagnosis in hospitalized patients. Variable symptom presentation
contributes to the challenge of detecting delirium and it is frequently
misdiagnosed as “sedation”, “confusion” or “anxiety”.
Deliriumincreases per patient cost by approximately $24,000 and results in up to
8 additional hospital days. Total United States health care costs for delirium
are estimated to be as high as $152 billion dollars which is equal to
the combined annual cost of both nonfatal falls and diabetes. This fiscal cost
does not consider the suffering endured by afflicted patients and families. Up
to 80% of those who remember their delirious episode report it to be the worst
nightmare of their lives. Some patients experience a post delirium cognitive
decline that may be permanent or progressive, especially in the case of preexisting
dementia. The distress that occurs in delirium is multidimensional for all
involved. Severe distress has been reported by 76% of family members and 73% of
nurses caring for patients with delirium. There may be worry on the part of
patients’ families that their loved one is “going crazy” and that the change
will be permanent. Delirium may also result in the loss of patient dignity and
complicates discharge planning. Family members often feel a sense of
helplessness, frustration and guilt. For the health professional, delirium
symptoms are difficult to assess and manage.
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