Sophie T Williams1, Jugdeep K Dhesi2,3, Judith S L Partridge2,3. 1. Perioperative Medicine for Older People Undergoing Surgery (POPS), Department of Ageing and Health, St Thomas' Hospital, Westminster Bridge Road, London, UK. sophie.1.williams@kcl.ac.uk. 2. Perioperative Medicine for Older People Undergoing Surgery (POPS), Department of Ageing and Health, St Thomas' Hospital, Westminster Bridge Road, London, UK. 3. Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Abstract
PURPOSE: Delirium is a common clinical syndrome associated with increased physical and psychological morbidity, mortality, inpatient stay and healthcare costs. There is growing interest in understanding the delirium experience and its psychological impact, including distress, for patients and their relatives, carers and healthcare providers. METHODS: This narrative review focuses on distress in delirium (DID) with an emphasis on its effect on older patients. It draws on qualitative and quantitative research to describe patient and environmental risk factors and variations in DID across a number of clinical settings, including medical and surgical inpatient wards and end of life care. The article provides an overview of the available distress assessment tools, both for clinical and research practice, and outlines their use in the context of delirium. This review also outlines established and emerging management strategies, focusing primarily on prevention and limitation of distress in delirium. RESULTS: Both significant illness and delirium cause distress. Patients who recall the episode of delirium describe common experiential features of delirium and distress. Relatives who witness delirium also experience distress, at levels suggested to be greater than that experienced by patients themselves. DID results in long-term psychological sequelae that can last months and years. Preventative actions, such pre-episode educational information for patients and their families in those at risk may reduce distress and psychological morbidity. CONCLUSIONS: Improving clinicians' understanding of the experience and long term psychological harm of delirium will enable the development of targeted support and information to patients at risk of delirium, and their families or carers.
PURPOSE:Delirium is a common clinical syndrome associated with increased physical and psychological morbidity, mortality, inpatient stay and healthcare costs. There is growing interest in understanding the delirium experience and its psychological impact, including distress, for patients and their relatives, carers and healthcare providers. METHODS: This narrative review focuses on distress in delirium (DID) with an emphasis on its effect on older patients. It draws on qualitative and quantitative research to describe patient and environmental risk factors and variations in DID across a number of clinical settings, including medical and surgical inpatient wards and end of life care. The article provides an overview of the available distress assessment tools, both for clinical and research practice, and outlines their use in the context of delirium. This review also outlines established and emerging management strategies, focusing primarily on prevention and limitation of distress in delirium. RESULTS: Both significant illness and delirium cause distress. Patients who recall the episode of delirium describe common experiential features of delirium and distress. Relatives who witness delirium also experience distress, at levels suggested to be greater than that experienced by patients themselves. DID results in long-term psychological sequelae that can last months and years. Preventative actions, such pre-episode educational information for patients and their families in those at risk may reduce distress and psychological morbidity. CONCLUSIONS: Improving clinicians' understanding of the experience and long term psychological harm of delirium will enable the development of targeted support and information to patients at risk of delirium, and their families or carers.
Authors: Judith S L Partridge; Siobhan Crichton; Elizabeth Biswell; Danielle Harari; Finbarr C Martin; Jugdeep K Dhesi Journal: Int J Geriatr Psychiatry Date: 2019-04-29 Impact factor: 3.485
Authors: Jo Ellen Wilson; Matthew F Mart; Colm Cunningham; Yahya Shehabi; Timothy D Girard; Alasdair M J MacLullich; Arjen J C Slooter; E Wesley Ely Journal: Nat Rev Dis Primers Date: 2020-11-12 Impact factor: 65.038
Authors: Therese G Poulin; Karla D Krewulak; Brianna K Rosgen; Henry T Stelfox; Kirsten M Fiest; Stephana J Moss Journal: BMC Health Serv Res Date: 2021-11-05 Impact factor: 2.655