[Skip to Content]
[Skip to Content Landing]

Delirium in Older PersonsAdvances in Diagnosis and Treatment

Educational Objective
To review the clinical management of patients with delirium.
1 Credit CME
Key Points

Question  What advances in diagnosis, prevention, and management of delirium in older adults have been introduced in the last 6 years?

Findings  Brief screening tools and improved delirium severity measurement tools have been developed for recognition and risk stratification of delirium. Delirium prevention with nonpharmacologic multicomponent strategies is effective. For pharmacologic management of delirium, the benefits do not outweigh the harms, and recommendations are to reserve treatment for patients with severe agitation that poses safety risks.

Meaning  Advances in screening and diagnosis of delirium can improve recognition and risk stratification, while implementation of nonpharmacologic delirium prevention strategies can substantially improve outcomes among older patients.

Abstract

Importance  Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual’s function and quality of life, as well as broad societal effects with substantial health care costs.

Objective  To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field.

Evidence Review  Search of Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011, until March 16, 2017, using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non–English-language articles were excluded.

Findings  Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment; 4 A’s Test; and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method–Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff safety or threatens interruption of essential medical therapies.

Conclusions and Relevance  Advances in diagnosis can improve recognition and risk stratification of delirium. Prevention of delirium using nonpharmacologic approaches is documented to be effective, while pharmacologic prevention and treatment of delirium remains controversial.

Sign in to take quiz and track your certificates

Buy This Activity
Article Information

Corresponding Author: Esther S. Oh, MD, PhD, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Seventh Floor, Baltimore, MD 21224 (eoh9@jhmi.edu).

Accepted for Publication: August 9, 2017.

Author Contributions: Drs Oh and Inouye had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Hshieh.

Obtained funding: Inouye.

Administrative, technical, or material support: Oh, Hshieh, Inouye.

Supervision: Oh, Inouye.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Funding/Support: This work was supported in part by grant K23AG043504 from the National Institutes of Health/National Institute on Aging (NIA) (Dr Oh); the Roberts Fund (Dr Oh); grant 3UL1TR001102 from the National Center for Advancing Translational Sciences (Dr Fong); grants P01AG031720 (Dr Inouye), R24AG054259 (Dr Inouye), R01AG044518 (Dr Inouye), and K07AG041835 (Dr Inouye) from the NIA; and by the Milton and Shirley F. Levy Family Chair (Dr Inouye).

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We gratefully acknowledge the assistance of Asha Albuquerque, BA, and Alexandra Pletnikova, BA, for the literature review in this study and the assistance of Eyal Kimchi, MD, PhD (Department of Neurology, Massachusetts General Hospital, Harvard Medical School), for his critical review of an earlier draft of this manuscript. We are also grateful to Carrie Price, MLS (William H. Welch Medical Library, the Johns Hopkins University School of Medicine), for her assistance with the literature search. These persons received no extra compensation for their contributions. This work is dedicated to the memory of Joshua Bryan Inouye Helfand and Lynne Morishita.

References
1.
Inouye  SK, Westendorp  RG, Saczynski  JS.  Delirium in elderly people.  Lancet. 2014;383(9920):911-922.PubMedGoogle ScholarCrossref
2.
Hustey  FM, Meldon  S, Palmer  R.  Prevalence and documentation of impaired mental status in elderly emergency department patients.  Acad Emerg Med. 2000;7(10):1166.PubMedGoogle Scholar
3.
Inouye  SK, Foreman  MD, Mion  LC, Katz  KH, Cooney  LM  Jr.  Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings.  Arch Intern Med. 2001;161(20):2467-2473.PubMedGoogle ScholarCrossref
4.
de la Cruz  M, Fan  J, Yennu  S,  et al.  The frequency of missed delirium in patients referred to palliative care in a comprehensive cancer center.  Support Care Cancer. 2015;23(8):2427-2433.PubMedGoogle ScholarCrossref
5.
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Society; 2013.
6.
World Health Organization.  The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, Switzerland: World Health Organization; 1993.
7.
Inouye  SK, van Dyck  CH, Alessi  CA, Balkin  S, Siegal  AP, Horwitz  RI.  Clarifying confusion: the Confusion Assessment Method: a new method for detection of delirium.  Ann Intern Med. 1990;113(12):941-948.PubMedGoogle ScholarCrossref
8.
Wei  LA, Fearing  MA, Sternberg  EJ, Inouye  SK.  The Confusion Assessment Method: a systematic review of current usage.  J Am Geriatr Soc. 2008;56(5):823-830.PubMedGoogle ScholarCrossref
9.
Robinson  TN, Raeburn  CD, Tran  ZV, Brenner  LA, Moss  M.  Motor subtypes of postoperative delirium in older adults.  Arch Surg. 2011;146(3):295-300.PubMedGoogle ScholarCrossref
10.
Kim  SY, Kim  SW, Kim  JM,  et al.  Differential associations between delirium and mortality according to delirium subtype and age: a prospective cohort study.  Psychosom Med. 2015;77(8):903-910.PubMedGoogle ScholarCrossref
11.
Borson  S, Scanlan  J, Brush  M, Vitaliano  P, Dokmak  A.  The Mini-Cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly.  Int J Geriatr Psychiatry. 2000;15(11):1021-1027.PubMedGoogle ScholarCrossref
12.
Pfeiffer  E.  A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.  J Am Geriatr Soc. 1975;23(10):433-441.PubMedGoogle ScholarCrossref
13.
Straus  SE, Thorpe  KE, Holroyd-Leduc  J.  How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?  JAMA. 2006;296(16):2012-2022.PubMedGoogle ScholarCrossref
14.
Attia  J, Hatala  R, Cook  DJ, Wong  JG.  The Rational Clinical Examination: does this adult patient have acute meningitis?  JAMA. 1999;282(2):175-181.PubMedGoogle ScholarCrossref
15.
Metersky  ML, Williams  A, Rafanan  AL.  Retrospective analysis: are fever and altered mental status indications for lumbar puncture in a hospitalized patient who has not undergone neurosurgery?  Clin Infect Dis. 1997;25(2):285-288.PubMedGoogle ScholarCrossref
16.
Lai  MM, Wong Tin Niam  DM.  Intracranial cause of delirium: computed tomography yield and predictive factors.  Intern Med J. 2012;42(4):422-427.PubMedGoogle ScholarCrossref
17.
Gross  AL, Jones  RN, Habtemariam  DA,  et al.  Delirium and long-term cognitive trajectory among persons with dementia.  Arch Intern Med. 2012;172(17):1324-1331.PubMedGoogle ScholarCrossref
18.
Fick  DM, Steis  MR, Waller  JL, Inouye  SK.  Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults.  J Hosp Med. 2013;8(9):500-505.PubMedGoogle ScholarCrossref
19.
Morandi  A, Davis  D, Fick  DM,  et al.  Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients.  J Am Med Dir Assoc. 2014;15(5):349-354.PubMedGoogle ScholarCrossref
20.
Jorm  AF.  A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation.  Psychol Med. 1994;24(1):145-153.PubMedGoogle ScholarCrossref
21.
Yesavage  JA, Brink  TL, Rose  TL,  et al.  Development and validation of a geriatric depression screening scale: a preliminary report.  J Psychiatr Res. 1982-1983;17(1):37-49.PubMedGoogle ScholarCrossref
22.
Hshieh  TT, Yue  J, Oh  E,  et al.  Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis.  JAMA Intern Med. 2015;175(4):512-520.PubMedGoogle ScholarCrossref
23.
American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults.  American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults.  J Am Geriatr Soc. 2015;63(1):142-150.PubMedGoogle ScholarCrossref
24.
Reade  MC, Finfer  S.  Sedation and delirium in the intensive care unit.  N Engl J Med. 2014;370(5):444-454.PubMedGoogle ScholarCrossref
25.
Hayhurst  CJ, Pandharipande  PP, Hughes  CG.  Intensive care unit delirium: a review of diagnosis, prevention, and treatment.  Anesthesiology. 2016;125(6):1229-1241.PubMedGoogle ScholarCrossref
26.
Higgins  JP, Altman  DG, Gøtzsche  PC,  et al; Cochrane Bias Methods Group; Cochrane Statistical Methods Group.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.  BMJ. 2011;343:d5928.PubMedGoogle ScholarCrossref
27.
Inouye  SK, Marcantonio  ER, Kosar  CM,  et al.  The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients.  Alzheimers Dement. 2016;12:766-775. PubMedGoogle ScholarCrossref
28.
Marcantonio  ER, Ngo  LH, O’Connor  M,  et al.  3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study.  Ann Intern Med. 2014;161(8):554-561.PubMedGoogle ScholarCrossref
29.
Inouye  SK, Kosar  CM, Tommet  D,  et al.  The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts.  Ann Intern Med. 2014;160(8):526-533.PubMedGoogle ScholarCrossref
30.
Bellelli  G, Morandi  A, Davis  DH,  et al.  Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people.  Age Ageing. 2014;43(4):496-502.PubMedGoogle ScholarCrossref
31.
Tieges  Z, Stíobhairt  A, Scott  K,  et al.  Development of a smartphone application for the objective detection of attentional deficits in delirium.  Int Psychogeriatr. 2015;27(8):1251-1262.PubMedGoogle ScholarCrossref
32.
Steis  MR, Evans  L, Hirschman  KB,  et al.  Screening for delirium using family caregivers: convergent validity of the Family Confusion Assessment Method and interviewer-rated Confusion Assessment Method.  J Am Geriatr Soc. 2012;60(11):2121-2126.PubMedGoogle Scholar
33.
Rhodius-Meester  HF, van Campen  JP, Fung  W, Meagher  DJ, van Munster  BC, de Jonghe  JF.  Development and validation of the Informant Assessment of Geriatric Delirium Scale (I-AGeD): recognition of delirium in geriatric patients [in Dutch].  Tijdschr Gerontol Geriatr. 2013;44(5):206-214.PubMedGoogle ScholarCrossref
34.
Salih  SA, Paul  S, Klein  K, Lakhan  P, Gray  L.  Screening for delirium within the interRAI acute care assessment system.  J Nutr Health Aging. 2012;16(8):695-700.PubMedGoogle ScholarCrossref
35.
O’Regan  NA, Ryan  DJ, Boland  E,  et al.  Attention! a good bedside test for delirium?  J Neurol Neurosurg Psychiatry. 2014;85(10):1122-1131.PubMedGoogle ScholarCrossref
36.
Voyer  P, Champoux  N, Desrosiers  J,  et al.  Recognizing acute delirium as part of your routine [RADAR]: a validation study.  BMC Nurs. 2015;14(19):19.PubMedGoogle ScholarCrossref
37.
Lin  HS, Eeles  E, Pandy  S, Pinsker  D, Brasch  C, Yerkovich  S.  Screening in delirium: a pilot study of two screening tools, the Simple Query for Easy Evaluation of Consciousness and Simple Question in Delirium.  Australas J Ageing. 2015;34(4):259-264.PubMedGoogle ScholarCrossref
38.
Shulman  RW, Kalra  S, Jiang  JZ.  Validation of the Sour Seven Questionnaire for screening delirium in hospitalized seniors by informal caregivers and untrained nurses.  BMC Geriatr. 2016;16(1):44.PubMedGoogle ScholarCrossref
39.
Bossuyt  PM, Reitsma  JB, Bruns  DE,  et al; STARD Group.  Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.  Clin Chem Lab Med. 2003;41(1):68-73.PubMedGoogle ScholarCrossref
40.
De  J, Wand  AP.  Delirium screening: a systematic review of delirium screening tools in hospitalized patients.  Gerontologist. 2015;55(6):1079-1099.PubMedGoogle ScholarCrossref
41.
Neufeld  KJ, Leoutsakos  JS, Sieber  FE,  et al.  Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly.  Br J Anaesth. 2013;111(4):612-618.PubMedGoogle ScholarCrossref
42.
Chester  JG, Beth Harrington  M, Rudolph  JL; VA Delirium Working Group.  Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening.  J Hosp Med. 2012;7(5):450-453.PubMedGoogle ScholarCrossref
43.
Morandi  A, Han  JH, Meagher  D,  et al.  Detecting delirium superimposed on dementia: evaluation of the diagnostic performance of the Richmond Agitation and Sedation Scale.  J Am Med Dir Assoc. 2016;17(9):828-833.PubMedGoogle ScholarCrossref
44.
Trzepacz  PT, Mittal  D, Torres  R, Kanary  K, Norton  J, Jimerson  N.  Validation of the Delirium Rating Scale-Revised-98: comparison with the delirium rating scale and the cognitive test for delirium.  J Neuropsychiatry Clin Neurosci. 2001;13(2):229-242.PubMedGoogle ScholarCrossref
45.
Breitbart  W, Rosenfeld  B, Roth  A, Smith  MJ, Cohen  K, Passik  S.  The Memorial Delirium Assessment Scale.  J Pain Symptom Manage. 1997;13(3):128-137.PubMedGoogle ScholarCrossref
46.
Vasunilashorn  SM, Marcantonio  ER, Gou  Y,  et al.  Quantifying the severity of a delirium episode throughout hospitalization: the combined importance of intensity and duration.  J Gen Intern Med. 2016;31(10):1164-1171.PubMedGoogle ScholarCrossref
47.
Scheffer  AC, van Munster  BC, Schuurmans  MJ, de Rooij  SE.  Assessing severity of delirium by the Delirium Observation Screening Scale.  Int J Geriatr Psychiatry. 2011;26(3):284-291.PubMedGoogle ScholarCrossref
48.
Saczynski  JS, Kosar  CM, Xu  G,  et al.  A tale of two methods: chart and interview methods for identifying delirium.  J Am Geriatr Soc. 2014;62(3):518-524.PubMedGoogle ScholarCrossref
49.
Neufeld  KJ, Nelliot  A, Inouye  SK,  et al.  Delirium diagnosis methodology used in research: a survey-based study.  Am J Geriatr Psychiatry. 2014;22(12):1513-1521.PubMedGoogle ScholarCrossref
50.
Dillon  ST, Vasunilashorn  SM, Ngo  L,  et al.  Higher C-reactive protein levels predict postoperative delirium in older patients undergoing major elective surgery: a longitudinal nested case-control study.  Biol Psychiatry. 2017;81(2):145-153.PubMedGoogle ScholarCrossref
51.
Tu  TM, Loh  NK, Tan  NC.  Clinical risk factors for non-convulsive status epilepticus during emergent electroencephalogram.  Seizure. 2013;22(9):794-797.PubMedGoogle ScholarCrossref
52.
Sutter  R, Rüegg  S, Tschudin-Sutter  S.  Seizures as adverse events of antibiotic drugs: a systematic review.  Neurology. 2015;85(15):1332-1341.PubMedGoogle ScholarCrossref
53.
Whitlock  EL, Torres  BA, Lin  N,  et al.  Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial.  Anesth Analg. 2014;118(4):809-817.PubMedGoogle ScholarCrossref
54.
Chan  MT, Cheng  BC, Lee  TM, Gin  T; CODA Trial Group.  BIS-guided anesthesia decreases postoperative delirium and cognitive decline.  J Neurosurg Anesthesiol. 2013;25(1):33-42.PubMedGoogle ScholarCrossref
55.
Wildes  TS, Winter  AC, Maybrier  HR,  et al.  Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: a pragmatic, randomised clinical trial.  BMJ Open. 2016;6(6):e011505.PubMedGoogle ScholarCrossref
56.
American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults.  Postoperative delirium in older adults: best practice statement from the American Geriatrics Society.  J Am Coll Surg. 2015;220(2):136-148.PubMedGoogle ScholarCrossref
57.
Inouye  SK, Bogardus  ST  Jr, Charpentier  PA,  et al.  A multicomponent intervention to prevent delirium in hospitalized older patients.  N Engl J Med. 1999;340(9):669-676.PubMedGoogle ScholarCrossref
58.
Martinez  F, Tobar  C, Hill  N.  Preventing delirium: should non-pharmacological, multicomponent interventions be used? a systematic review and meta-analysis of the literature.  Age Ageing. 2015;44(2):196-204.PubMedGoogle ScholarCrossref
59.
Akunne  A, Davis  S, Westby  M, Young  J.  The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture.  Eur J Orthop Surg Traumatol. 2014;24(2):187-195.PubMedGoogle ScholarCrossref
60.
Siddiqi  N, Harrison  JK, Clegg  A,  et al.  Interventions for preventing delirium in hospitalised non-ICU patients.  Cochrane Database Syst Rev. 2016;3:CD005563.PubMedGoogle Scholar
61.
Goldberg  S, Bradshaw  L, Whittamore  K, Gladman  J, Harwood  R.  Comparison of a specialist Medical and Mental Health Unit with standard care for older people with delirium and dementia admitted to a general hospital: a randomised controlled trial (NIHR TEAM trial).  Eur Geriatr Med. 2013;4(suppl 1):S173.Google ScholarCrossref
62.
Cheong  CY, Tan  JA, Foong  YL,  et al.  Creative music therapy in an acute care setting for older patients with delirium and dementia.  Dement Geriatr Cogn Dis Extra. 2016;6(2):268-275.PubMedGoogle ScholarCrossref
63.
Kratz  T, Heinrich  M, Schlauß  E, Diefenbacher  A.  Preventing postoperative delirium.  Dtsch Arztebl Int. 2015;112(17):289-296.PubMedGoogle Scholar
64.
Clegg  A, Siddiqi  N, Heaven  A, Young  J, Holt  R.  Interventions for preventing delirium in older people in institutional long-term care.  Cochrane Database Syst Rev. 2014;(1):CD009537.PubMedGoogle Scholar
65.
Gagnon  P, Allard  P, Gagnon  B, Mérette  C, Tardif  F.  Delirium prevention in terminal cancer: assessment of a multicomponent intervention.  Psychooncology. 2012;21(2):187-194.PubMedGoogle ScholarCrossref
66.
González-Gil  T.  Interventions for preventing delirium in older people in institutional long-term care.  Int J Nurs Stud. 2016;55:133-134.PubMedGoogle ScholarCrossref
67.
Fukata  S, Kawabata  Y, Fujisiro  K,  et al.  Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial.  Surg Today. 2014;44(12):2305-2313.PubMedGoogle ScholarCrossref
68.
Hakim  SM, Othman  AI, Naoum  DO.  Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: a randomized trial.  Anesthesiology. 2012;116(5):987-997.PubMedGoogle ScholarCrossref
69.
Vochteloo  AJ, Moerman  S, van der Burg  BL,  et al.  Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium.  BMC Geriatr. 2011;11:39.PubMedGoogle ScholarCrossref
70.
Wang  W, Li  HL, Wang  DX,  et al.  Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial.  Crit Care Med. 2012;40(3):731-739.PubMedGoogle ScholarCrossref
71.
Al-Aama  T, Brymer  C, Gutmanis  I, Woolmore-Goodwin  SM, Esbaugh  J, Dasgupta  M.  Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial.  Int J Geriatr Psychiatry. 2011;26(7):687-694.PubMedGoogle ScholarCrossref
72.
de Jonghe  A, van Munster  BC, Goslings  JC,  et al; Amsterdam Delirium Study Group.  Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial.  CMAJ. 2014;186(14):E547-E556.PubMedGoogle ScholarCrossref
73.
Hatta  K, Kishi  Y, Wada  K,  et al; DELIRIA-J Group.  Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial.  JAMA Psychiatry. 2014;71(4):397-403.PubMedGoogle ScholarCrossref
74.
Ashraf  JM, Schweiger  M, Vallurupalli  N, Bellantonio  S, Cook  JR.  Effects of oral premedication on cognitive status of elderly patients undergoing cardiac catheterization.  J Geriatr Cardiol. 2015;12(3):257-262.PubMedGoogle Scholar
75.
Lurati Buse  GA, Schumacher  P, Seeberger  E,  et al.  Randomized comparison of sevoflurane versus propofol to reduce perioperative myocardial ischemia in patients undergoing noncardiac surgery.  Circulation. 2012;126(23):2696-2704.PubMedGoogle ScholarCrossref
76.
Oh  CS, Rhee  KY, Yoon  TG, Woo  NS, Hong  SW, Kim  SH.  Postoperative delirium in elderly patients undergoing hip fracture surgery in the sugammadex era: a retrospective study.  Biomed Res Int. 2016;2016:1054597.PubMedGoogle Scholar
77.
Stoppe  C, Fahlenkamp  AV, Rex  S,  et al.  Feasibility and safety of xenon compared with sevoflurane anaesthesia in coronary surgical patients: a randomized controlled pilot study.  Br J Anaesth. 2013;111(3):406-416.PubMedGoogle ScholarCrossref
78.
Whitlock  RP, Devereaux  PJ, Teoh  KH,  et al; SIRS Investigators.  Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial.  Lancet. 2015;386(10000):1243-1253.PubMedGoogle ScholarCrossref
79.
Djaiani  G, Silverton  N, Fedorko  L,  et al.  Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery: a randomized controlled trial.  Anesthesiology. 2016;124(2):362-368.PubMedGoogle ScholarCrossref
80.
Liu  Y, Ma  L, Gao  M, Guo  W, Ma  Y.  Dexmedetomidine reduces postoperative delirium after joint replacement in elderly patients with mild cognitive impairment.  Aging Clin Exp Res. 2016;28(4):729-736.PubMedGoogle ScholarCrossref
81.
Li  X, Yang  J, Nie  XL,  et al.  Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: a randomized controlled trial.  PLoS One. 2017;12(2):e0170757.PubMedGoogle ScholarCrossref
82.
Dighe  K, Clarke  H, McCartney  CJ, Wong  CL.  Perioperative gabapentin and delirium following total knee arthroplasty: a post-hoc analysis of a double-blind randomized placebo-controlled trial.  Can J Anaesth. 2014;61(12):1136-1137.PubMedGoogle ScholarCrossref
83.
Marcantonio  ER, Palihnich  K, Appleton  P, Davis  RB.  Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture.  J Am Geriatr Soc. 2011;59(suppl 2):S282-S288.PubMedGoogle ScholarCrossref
84.
Papadopoulos  G, Pouangare  M, Papathanakos  G, Arnaoutoglou  E, Petrou  A, Tzimas  P.  The effect of ondansetron on postoperative delirium and cognitive function in aged orthopedic patients.  Minerva Anestesiol. 2014;80(4):444-451.PubMedGoogle Scholar
85.
Pesonen  A, Suojaranta-Ylinen  R, Hammarén  E,  et al.  Pregabalin has an opioid-sparing effect in elderly patients after cardiac surgery: a randomized placebo-controlled trial.  Br J Anaesth. 2011;106(6):873-881.PubMedGoogle ScholarCrossref
86.
Saager  L, Duncan  AE, Yared  JP,  et al.  Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery.  Anesthesiology. 2015;122(6):1214-1223.PubMedGoogle ScholarCrossref
87.
Gruber-Baldini  AL, Marcantonio  E, Orwig  D,  et al.  Delirium outcomes in a randomized trial of blood transfusion thresholds in hospitalized older adults with hip fracture.  J Am Geriatr Soc. 2013;61(8):1286-1295.PubMedGoogle ScholarCrossref
88.
Radtke  FM, Franck  M, Lendner  J, Krüger  S, Wernecke  KD, Spies  CD.  Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction.  Br J Anaesth. 2013;110(suppl 1):i98-i105.PubMedGoogle ScholarCrossref
89.
Boockvar  KS, Teresi  JA, Inouye  SK.  Preliminary data: an adapted hospital elder life program to prevent delirium and reduce complications of acute illness in long-term care delivered by certified nursing assistants.  J Am Geriatr Soc. 2016;64(5):1108-1113.PubMedGoogle ScholarCrossref
90.
Kolanowski  A, Fick  D, Litaker  M,  et al.  Effect of cognitively stimulating activities for the symptom management of delirium superimposed on dementia: a randomized controlled trial.  J Am Geriatr Soc. 2016;64(12):2424-2432.PubMedGoogle ScholarCrossref
91.
Van Rompaey  B, Elseviers  MM, Van Drom  W, Fromont  V, Jorens  PG.  The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients.  Crit Care. 2012;16(3):R73.PubMedGoogle ScholarCrossref
92.
Yang  J, Choi  W, Ko  YH, Joe  SH, Han  C, Kim  YK.  Bright light therapy as an adjunctive treatment with risperidone in patients with delirium: a randomized, open, parallel group study.  Gen Hosp Psychiatry. 2012;34(5):546-551.PubMedGoogle ScholarCrossref
93.
Atalan  N, Efe Sevim  M, Akgün  S, Fazlıoğulları  O, Başaran  C.  Morphine is a reasonable alternative to haloperidol in the treatment of postoperative hyperactive-type delirium after cardiac surgery.  J Cardiothorac Vasc Anesth. 2013;27(5):933-938.PubMedGoogle ScholarCrossref
94.
Boettger  S, Jenewein  J, Breitbart  W.  Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: a comparison of efficacy, safety, and side effects.  Palliat Support Care. 2015;13(4):1079-1085.PubMedGoogle ScholarCrossref
95.
Kishi  Y, Kato  M, Okuyama  T, Thurber  S.  Treatment of delirium with risperidone in cancer patients.  Psychiatry Clin Neurosci. 2012;66(5):411-417.PubMedGoogle ScholarCrossref
96.
Maneeton  B, Maneeton  N, Srisurapanont  M, Chittawatanarat  K.  Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial.  Drug Des Devel Ther. 2013;7:657-667.PubMedGoogle ScholarCrossref
97.
Schrøder Pedersen  S, Kirkegaard  T, Balslev Jørgensen  M, Lind Jørgensen  V.  Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium: a prospective cohort study.  Interact Cardiovasc Thorac Surg. 2014;18(4):438-445.PubMedGoogle ScholarCrossref
98.
Yoon  HJ, Park  KM, Choi  WJ,  et al.  Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium.  BMC Psychiatry. 2013;13:240.PubMedGoogle ScholarCrossref
99.
Agar  MR, Lawlor  PG, Quinn  S,  et al.  Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: a randomized clinical trial.  JAMA Intern Med. 2017;177(1):34-42.PubMedGoogle ScholarCrossref
100.
Neufeld  KJ, Yue  J, Robinson  TN, Inouye  SK, Needham  DM.  Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis.  J Am Geriatr Soc. 2016;64(4):705-714.PubMedGoogle ScholarCrossref
101.
Maclullich  AM, Ferguson  KJ, Miller  T, de Rooij  SE, Cunningham  C.  Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses.  J Psychosom Res. 2008;65(3):229-238.PubMedGoogle ScholarCrossref
102.
Westhoff  D, Witlox  J, Koenderman  L,  et al.  Preoperative cerebrospinal fluid cytokine levels and the risk of postoperative delirium in elderly hip fracture patients.  J Neuroinflammation. 2013;10(1):122.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements