Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineThe following information will aid in the interpretation and use of Table I (Assessment of theclinical features a person can exhibit regarding delirium, dementia and depression), and willalso aid in differentiating between the disorders.DeliriumDSM-IV-TR is the standard for identifying the following diagnostic criteria for delirium:A. Disturbances of consciousness (e.g., reduced clarity of awareness of the environment)with reduced ability to focus, sustain or shift attention.B. A change in cognition (such as memory deficit, disorientation, language disturbance)or the development of a perceptual disturbance that is not better accounted for by apreexisting, established or evolving dementia.27C. The disturbance develops over a short period of time (usually hours to days) and tendsto fluctuate during the course of the day.D. There is evidence from the history, physical examination or laboratory findings that thedisturbance is caused by the direct physiological consequences of a general medical condition.Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.Copyright 2000 American Psychiatric Association.Delirium also has associated features such as sleep-wake cycle disturbances and alteredpsychomotor behaviour. Behavioural manifestations of individuals with delirium mayalso include: attempts to escape one’s environment (often resulting in falls). removal of medical equipment (e.g., intravenous lines, catheters). disturbances in vocalizations (e.g., screaming, calling out, complaining, cursing,muttering, moaning). hyperactivity (restless state, constant motion), hypoactivity (inactive, withdrawn,sluggish state) or a combination of the two. a predilection to attack others (APA, 1995; Lipowski, 1983).In the community, care providers might see behavioural manifestations of delirium includinginappropriate phone calls to emergency rooms, mismanaging medications, taking thingsapart and/or leaving water running.