Review Article
Volume 16 Issue 2 - 2020
Delirium in Elderly
Nasreen Abdullah Ashour1*, Esraa Saleh Heji2, Mishaal Hisham Rayees3, Hawra Abdulkhaliq Al Shali4, Raed Saeed Alajrafi5, Talib Abdulaziz Aldakhil6, Malak Mahmoud Kurdi7, Suhaib Mohammed Amin Khan8, Ngoud Moghli Alaslani9, Rawan Abdullah Alsaedi10 and Abdullah Saeed Abu-kaftah11
1King Fahad General Hospital, Jeddah, Saudi Arabia
2Umm Al-Qura University, Saudi Arabia
3King Abdulziz University Hospital, Saudi Arabia
4Qatif Primary Healthcare, Saudi Arabia
5Imam Abdulrahman Bin Faisal University, Saudi Arabia
6Alqatif Central Hospital, Saudi Arabia
7Taibah University, Saudi Arabia
8King Abdulaziz University, Saudi Arabia
9King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
10Ibn Sina College, Saudi Arabia
11Armed Force Hospital Southern Region, Saudi Arabia
*Corresponding Author: Nasreen Abdullah Ashour, King Fahad General Hospital, Jeddah, Saudi Arabia.
Received: January 04, 2020; Published: January 08, 2020


Introduction: Delirium is defined as a clinical syndrome which is characterized by acute and fluctuating cognitive dysfunction, or acute state of confusion, which is usually transient, and happens as a result of another underlying medical condition. The prevalence of delirium in about 14 - 24% in hospital setting and 1 - 2% in community. The incidence is higher among the elderly, especially those in post-operative stage, in palliative care, or those requiring intensive care. Patients over age 65 in the intensive care unit (ICU) can haven in incidence of delirium as high as 85%. Delirium is also greatly associated with patients on ventilators. Delirium is associated with a cost of 4 - 16 billion dollars per year in the United States alone. It is also associated with increased duration of mechanical ventilation, rates of self extubation and prolonged hospital stay. Prolonged delirium in the ICU is directly associated with increased mortality, as well as long term cognitive dysfunction. Therefore, understanding the cause behind the condition, and its management is imperative. 

Objectives: In this review, we will discuss the management of delirium of patients in the intensive care department.

Methodology: We did a systematic search for management of delirium of patients in the intensive care department using PubMed search engine ( and Google Scholar search engine ( All relevant studies were retrieved and discussed. We only included full articles.

Conclusion: Delirium is a serious condition and a complication of hospitalization patients, especially in the elderly. It must be considered to be a medical emergency until proven otherwise. Delirium has the potential to significantly affect the overall outcome and prognosis of severely ill patients in the ICU. It also substantially increases the health-care utilization and costs. Interdisciplinary team approach with new guidelines for managing delirium leads use minimum sedation, reduced duration of mechanical ventilation, increase ventilator-free days, and better sleep hygiene. Restraints should only be used in refractory cases. More studies are needed to understand causes and risk factors for delirium to reduce incidence and enhance prevention in the ICU patients. 

Keywords: Delirium; Acute Confusion; Intensive Care Unit; Palliative Care; Treatment of Delirium


  1. Morandi A., et al. “Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients”. Intensive Care Medicine 34 (2008): 1907-1915.
  2. Ely EW., et al. “The impact of delirium in the intensive care unit on hospital length of stay”. Intensive Care Medicine 27 (2001): 1892-1900.
  3. Inouye SK. “Predisposing and precipitating factors for delirium in hospitalized older patients”. Dementia and Geriatric Cognitive Disorders 10 (1999): 393-400.
  4. Bourne RS., et al. “Drug treatment of delirium: past, present and future”. Journal of Psychosomatic Research 65 (2008): 273-282.
  5. Popp J. “Delirium and cognitive decline: more than a coincidence”. Current Opinion in Neurology 26 (2013): 634-639.
  6. Clegg A and Young JB. “Which medications to avoid in people at risk of delirium: a systematic review”. Age Ageing 40 (2011): 23-29.
  7. Cerejeira J., et al. “The cholinergic system and inflammation: common pathways in delirium pathophysiology”. Journal of the American Geriatrics Society 60 (2012): 669-675.
  8. Khurana V., et al. “Evaluation of delirium in elderly: a hospital-based study”. Geriatrics and Gerontology International 11 (2011): 467-473.
  9. Guenther U., et al. “Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study”. Annals of Surgery 257 (2013): 1160-1167.
  10. Radtke FM., et al. “Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction”. British Journal of Anaesthesia 110.1 (2013): i98-105.
  11. Martins S and Fernandes L. “Delirium in elderly people: a review”. Frontiers in Neurology 3 (2012): 101.
  12. Cole MG. “Delirium in elderly patients”. The American Journal of Geriatric Psychiatry 12 (2004): 7-21.
  13. Saxena S and Lawley D. “Delirium in the elderly: a clinical review”. Postgraduate Medical Journal 85 (2009): 405-413.
  14. Burns A., et al. “Delirium”. Journal of Neurology, Neurosurgery, and Psychiatry 75 (2004): 362-367.
  15. Philpot M. “Diagnosing delirium”. Journal of Neurology, Neurosurgery, and Psychiatry 81 (2010): 827.
  16. Inouye SK. “Delirium in older persons”. The New England Journal of Medicine 354 (2006): 1157-1165.
  17. Wallesch CW and Hundsalz A. “Language function in delirium: a comparison of single word processing in acute confusional states and probable Alzheimer's disease”. Brain Lang 46 (1994): 592-606.
  18. Meagher DJ., et al. “Phenomenology of delirium. Assessment of 100 adult cases using standardised measures”. British Journal of Psychiatry 190 (2007): 135-141.
  19. Meagher DJ., et al. “Defining delirium for the International Classification of Diseases, 11th Revision”. Journal of Psychosomatic Research 65 (2008): 207-214.
  20. Laurila JV., et al. “The impact of different diagnostic criteria on prevalence rates for delirium”. Dementia and Geriatric Cognitive Disorders 16 (2003): 156-162.
  21. Wei LA., et al. “The Confusion Assessment Method: a systematic review of current usage”. Journal of the American Geriatrics Society 56 (2008): 823-830.
  22. Casarett DJ and Inouye SK. American College of Physicians-American Society of Internal Medicine End-of-Life Care Consensus P. “Diagnosis and management of delirium near the end of life”. Annals of Internal Medicine 135 (2001): 32-40.
  23. Chong MS., et al. “Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)”. Clinical Interventions in Aging 9 (2014): 603-612.
  24. Pitkala KH., et al. “Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial”. The Journals of Gerontology Series A Biological Sciences and Medical Sciences 61 (2006): 176-181.
  25. Overshott R., et al. “Rivastigmine in the treatment of delirium in older people: a pilot study”. International Psychogeriatrics 22 (2010): 812-818.
  26. Litvineneko IV., et al. “Efficacy and safety of rivastigmine (exelon) in the confusion syndrome in the acute phase of ischemic stroke”. Zh Nevrol Psikhiatr Im S S Korsakova 110 (2010): 36-41.
  27. Cerveira CCT., et al. “Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments”. Dementia and Neuropsychologia 11 (2017): 270-275.
Citation: Nasreen Abdullah Ashour., et al. “Delirium in Elderly”. EC Microbiology 16.2 (2020): 01-08.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

July Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the July issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for August Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the August issue of respective journals. Submissions are accepted on/before July 21, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to