Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineSeveral studies note that newly developing or acutely worsening agitation can be a sign of adeteriorating medical condition (APA, 1997). Clinicians should bear in mind that the elderlyand clients with dementia in general, are at high risk for delirium associated with medicalproblems, medications and surgery. For a listing of medications that may cause cognitiveimpairments, see Appendix N.Recommendation • 8Nurses should screen for suicidal ideation and intent when a high index of suspicion fordepression is present, and seek an urgent medical referral. Further, should the nurse havea high index of suspicion for delirium, an urgent medical referral is recommended.(Strength of Evidence = C – RNAO Consensus Panel, 2003)35Discussion of EvidenceSeveral studies suggest that depressive disorders are poorly recognized and under treated.Consequently, healthcare workers need to maintain a high index of suspicion and not relyon the client to raise the possibility that they are suffering from a mental health problem(NZGG, 1998). An urgent medical referral is recommended if the nurse has a high index ofsuspicion that the client has depression, because of the higher risk of morbidity and mortality(Foreman et al., 2001; Inouye, et al., 1998).A further search of the literature found strong evidence that clients with depression shouldbe carefully evaluated for suicide potential, as well as the potential for violence (APA, 1999). TheNew Zealand Guidelines Group (1998) also reports that suicidal thoughts and behaviour areclosely associated with mental illness, and the evaluation of such symptoms should alwaysinclude a full psychiatric assessment, usually by an appropriately trained team of mentalhealth professionals. It is widely believed that an interdisciplinary team offers a greater rangeof skills to meet the differing needs of clients who may be suicidal, and can also providesupervision and support to its members (APA, 1997).Several articles agree that while predicting suicide risk in an individual is difficult, there arecertain factors that have been associated with a greater potential for suicide. Refer toAppendix M for a list of factors.