Delirium/Altered Mental Status (AMS)
Carole K. H. Bartoo
Definition
1.Delirium is a syndrome caused by a medical condition or drug/medication side effect in which the person experiences an acute alteration in their mental status (AMS). Delirium most often occurs in the older patient and commonly is seen while hospitalized. The general signs and symptoms may include:
a.Changes in ability to concentrate or focus including but not limited to: inability to maintain a conversation, inability to focus on reading or watching media at previous level.
b.Changes in sensorium including but not limited to: flipping night and day, feeling a body part is moving or being touched when it is not, feeling they are standing or sitting when they are lying down, visual, tactile or auditory misinterpretation such as body part (hand, foot) is not their own, equipment such as IV tubing or nurse call light are something else (snake, calculator, etc.).
c.Changes in behavior such as agitation, anxiety, acting out, attempting to walk or get out of bed despite caregiver efforts to redirect, even sexual language or actions different from their previous baseline.
d.The changes occur rapidly within hours or days rather than weeks or months.
e.The changes fluctuate in severity or wax and wane with regard to the older adult’s baseline.
2.There are five key components that characterize delirium. Those components can be found in: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DMS-5). Delirium Diagnostic Criteria can be found at: www.wvgeriatrics.org.
3.Delirium is often superimposed on existing dementia. A family member or person who knows the older adult’s recent baseline should be asked if the mental status is a significant alteration from baseline. This helps providers delineate between baseline dementia and delirium.
4.Delirium is a common early sign of acute illness or infection in the elderly.
Screening
A.At a minimum, patients and family should be asked if the older adult has experienced episodes of AMS since their last visit.
B.The Brief Confusion Assessment Method (bCAM) is a well-documented assessment for delirium (www.mnhospitals.org/Portals/0/Documents/ptsafety/LEAPT%20Delirium/HELP%20Program%20CAM%20Flowsheet.pdf).