Guidelines for a Palliative Approach in Residential Aged Care

Table 17: Distinguishing delirium from dementia
Indicators Delirium Dementia
Onset Acute or subacute Insidious
Course
Fluctuating, usually resolves over days
to weeks
Progressive
*Activities of daily living (ADLs) Gradual decline in ability to do ADLs Sudden deterioration in
ability to do ADLs
Conscious level Often impaired, can fluctuate rapidly Clear until later stages
Cognitive defects
Poor short term memory, poor attention
span
Hallucinations Common, especially visual Often absent
Delusions Fleeting, non-systematised Often absent
Poor short term memory,
attention less affected until
severe
Psychomotor activity Increased, reduced, or unpredictable Can be normal
British Medical Journal, 2002, 325 (7365), 644–647, with permission from the BMJ Publishing
Group [295] * This indicator was added to the table developed by Brown (2002), and it is based upon
the work of McCusker and Colleagues (2003) [294]
7.4.2 Management
A systematic review of the effectiveness of prevention interventions for delirium in hospitalised
patients found that most interventions involved psychiatric or medical assessments, and
support education or reorientation, which had little effect for older persons due to comorbid
disorders [296] (Level II).
Prescribed drugs and acute infections are perhaps the most common cause of delirium,
particularly in older persons [295] (Level EO). Many prescribed drugs that can induce delirium
are sedating drugs such as benzodiazepines and narcotic analgesics. Precipitating causes also
need to be considered. These include the person’s age, co-morbid physical illness or dementia,
and environmental factors (such as visual or hearing impairment, social deprivation, and being
moved to a new environment) [295] (Level EO). Good management of delirium requires [294,295]
(Level IV; Level EO):
• identifying and treating the underlying causes;
• providing environmental and supportive measures;
• prescribing drugs aimed at managing symptoms; and
• following-up with a regular clinical review.
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