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Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Urinary incontinence can be a symptom of a variety of reversible conditions. Common and reversible causes of urinary incontinence include polyuria, exposure to irritants (including concentrated urine), infection, urinary retention, use of pharmaceuticals, stool impaction or constipation, atrophic urethritis or vaginitis, restricted mobility or dexterity, psychological conditions, and delirium or acute confused state. Healthcare professionals can use existing assessment strategies, tools, and parameters to guide decisions and treatment options to manage these conditions. First-line assessment tools are reviewed, including the use of a voiding and bowel diary, simple dipstick urinalysis, catheterization for post-void residual, the Folstein Mini Mental Status evaluation, and the Geriatric Depression Scale. Guidelines for estimating normal ranges of urine output, the influence of irritants, the risk of incontinence caused by stool impaction, and urinary retention are discussed. Primary care providers are well positioned to rule out or treat many of the reversible causes of urinary incontinence using simple assessment tools and pragmatic guidelines.
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PMID:Identifying and treating reversible causes of urinary incontinence. 1471 8

During the past two decades, significant research and several government and health care quality groups have advised against the use of physical restraints in hospitals and nursing homes, yet older adults are continuing to die, become injured or experience the iatrogenic complications associated with this practice. Deaths are usually caused by asphyxiation, but also occur from strangulation, or cardiac arrest. Older adults with dementia are at high risk for restraint use because of impaired memory, language, judgment and visual perception. In moderate to severe dementia, the risk of falls is greater because of gait apraxia and unsteadiness. Agitation, disorientation, and pacing behaviors from delirium or dementia can precipitate staff to use restraints to prevent harm to the older adult or to others. Physical restraints should be eliminated as an intervention in older adults with dementia because they are also very likely to cause acute functional decline, incontinence, pressure ulcers and regressive behaviors in a short period of time. The purpose of this paper is to disseminate the dangers of this clinical practice and to summarize the latest research in restraint free care and restraint alternatives in the United States.
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PMID:Restraint free care in older adults with dementia. 1607 57

The psychopathology of stroke encompasses several psychiatric and behavioral disorders that have high prevalence in the geriatric population, reduce the patient autonomy and increase the caregiver's burden. These disorders are usually associated with other cognitive and neurological deficits, and are labelled as neuropsychiatric when the whole clinical picture is consistent with the specific dysfunction of a neural system or brain region. Thus the neuropsychiatry of stroke comprises disorders of the perception/identification of the self and the environment (anosognosia of hemiplegia, misidentification syndromes, confabulations, visual hallucinations, delirium and acute confusional state), amotivational syndromes (apathy and athymhormia), disorders of emotional reactivity (blunted affect, emotional incontinence, irritability, catastrophic reactions), poor impulse or ideation control (mania) and personality changes. The clinical profile of the subcortical vascular dementia also points to specific brain dysfunction (frontal-subcortical pathways) that manifests with behavioral (depression, emotionalism, irritability) and cognitive symptoms (psychomotor retardation, attention, executive and memory deficits). However, post-stroke depression and anxiety, which have a more variable clinical presentation and might be assimilated, for several aspects, to post-traumatic or adaptive disorders, are disorders less characterized in their neural correlates.
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PMID:[Psychopathology of stroke]. 1631 15

Geriatricians have embraced the term "geriatric syndrome," using it extensively to highlight the unique features of common health conditions in older people. Geriatric syndromes, such as delirium, falls, incontinence, and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept has remained poorly defined. This article reviews criteria for defining geriatric syndromes and proposes a balanced approach of developing preliminary criteria based on peer-reviewed evidence. Based on a review of the literature, four shared risk factors-older age, baseline cognitive impairment, baseline functional impairment, and impaired mobility-were identified across five common geriatric syndromes (pressure ulcers, incontinence, falls, functional decline, and delirium). Understanding basic mechanisms involved in geriatric syndromes will be critical to advancing research and developing targeted therapeutic options, although given the complexity of these multifactorial conditions, attempts to define relevant mechanisms will need to incorporate more-complex models, including a focus on synergistic interactions between different risk factors. Finally, major barriers have been identified in translating research advances, such as preventive strategies of proven effectiveness for delirium and falls, into clinical practice and policy initiatives. National strategic initiatives are required to overcome barriers and to achieve clinical, research, and policy advances that will improve quality of life for older persons.
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PMID:Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. 1825 20

Identifiers of illness, including catastrophic change, are based on a set of assumptions that are not always true or accurate for older adults. Atypical findings in combination with the more subtle or different presentation of illness can result in missed opportunities for early treatment and prevention of more dire consequences. Assessment instruments described in this article can guide the investigation and communication of a resident's change in status: SPICES (Sleep; Problems with Eating and Feeding; Incontinence; Confusion; Evidence of Falls; Skin Breakdown), FANCAPES (Fluid; Aeration; Nutrition; Cognition/Communication; Activity/Abilities; Pain; Elimination; Skin/Socialization), DELIRIUM (Drug use: Electrolyte imbalance; Lack of scheduled meds; Infection; Reduced sensory input; Intracranial problems; Urinary problems; Myocardial problems), PQRST (Provokes/Palliates; Quality/Quantity; Region/Radiates; Severity; Timing) and COLDSPA (Character; Onset; Location; Duration; Severity; Pattern; Associated Symptoms), (for pain assessment). "Should I call?" scenarios are described using case studies. A systematic approach to assessment, recognition of change in functional status, protocols to guide calling for emergency assistance, and structured communication are essential elements of early recognition of illness, can reduce caregiver anxiety, and improve the health care outcomes for the resident. Imagine you or one of your staff standing in the dining room of your residence and looking at the residents for whose health and well-being you are responsible. Could you spot someone who was not doing well? Who might be ailing? If you saw 2 residents who looked ill, whom would you assess first? How would you decide? Identification of illness, including catastrophic change, is based on a set of assumptions that are not always true for older adults and can result in a set of findings that does not fit with our conventional understanding and knowledge of illness presentation. All too often, these atypical findings in combination with the more subtle presentation of illness in older adults results in missed opportunities for early treatment. A systematic approach to assessment, recognition of change, protocols to guide calling for emergency assistance, and communication with other health care providers are essential elements of early recognition of illness that can decrease health care provider anxiety and improve outcomes. This article describes 2 evidence-based assessment instruments: the SPICES tool, which should be used routinely as a first-line method for recognizing change and preventing deepening complications or acute illness, and the FANCAPES tool, which evaluates change in condition. In addition, several acronyms that can guide symptom assessment are provided. Immediately life-threatening conditions and 3 "don't miss" signs of emergencies are discussed, as are nursing interventions for the geriatric emergency. "Should I call?" scenarios are presented in a table that includes common signs and symptoms and recommended nursing actions of who to call. Two case studies illustrate the assessment instruments and analysis of data. Basic information that should be included in a transfer document is described. The article includes a communication model known as SBAR (Situation, Background, Assessment, Recommendation) that can be implemented and used by all staff of the assisted living residence.
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PMID:Resident condition change: should I call 911? 1826 74

In this report, we describe the case of two patients with Bickerstaff's brainstem encephalitis (BBE) who developed delirium manifested as emotional incontinence, restlessness, and aggressive behavior from disease onset. Serum anti-GQ1b and anti-GT1a IgG antibodies were detected in both patients. When unusual psychiatric symptoms are observed, in addition to acute ophthalmoplegia and ataxia, neurologists should take into account the possibility of BBE. Brain MRI findings were normal in both patients and SPECT was performed on only patient 1. SPECT of patient 1 showed reversible hypoperfusion in the brainstem, bilateral thalami, and medial frontal lobe. Brain SPECT appears to be useful for detecting lesions of the brainstem as well as the basal ganglia or cerebrum in BBE.
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PMID:Delirium in two patients with Bickerstaff's brainstem encephalitis. 1834 57

In first term, we define the current concepts in regard to psychosis (delirium and hallucinations) and abnormal behaviours (aggression, depression and mood changes such as mania, apathy, anxiety, agitation and desinhibition) in dementia. We also review the most used drugs in order to control these symptoms (typical and atypical antipsychotics, anti-epileptic drugs, benzodiazepines, SSRI, memantine and AcheI). As well, we take in consideration pharmacokinetic and pharmacodynamic characteristics, relationship to aging and interactions of these medications. Finally, we briefly describe the management of non-pharmacological of the most common behavioural symptoms: disruptive conducts such as exaggerated responses to minimal stimuli, catastrophic reaction, violence, anger and hostility, wandering and sundowning. As well, we discuss how to manage sleep disturbances, sexual aggression, incontinence and dressing apraxia. Management of these conditions involves, in first term, a comprehensive understanding of the whole situation and identification of underlying possible causes will make possible to evaluate results. This approach will lead to a more rationale proposal of psychotherapeutic and behavioural techniques, and milieu modifications. Finaly, we consider safety patient's in the community as well as the risk of abuse originated in a non-healthy patient-caregiver relationship.
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PMID:[Behavioural and psychological signs in dementia. Clinical features. Pharmacological and non-pharmacological treatment strategies]. 1839 11

Delirious mania also known as Bell mania is a syndrome of excitement, delirium, and psychosis, of acute onset. We report 2 patients who presented with acute onset of disorientation, aggressive behavior, double incontinence, grandiose ideas, and auditory hallucinations. Results of investigations to rule out organic etiology such as computed tomographic scan of brain, cerebrospinal fluid examination, and biochemical parameters were normal. Creatine kinase levels were only moderately elevated. A provisional diagnosis of delirious mania was made, and patients were empirically started on electroconvulsive therapy (ECT) session. Delirium resolved by the second ECT session, unmasking manic symptoms, and recovered completely at the end of sixth ECT session. Prophylactic lithium was started, and both patients continue to be in remission after 1 year. Differential diagnosis of the above clinical presentation includes neuroleptic malignant syndrome and malignant catatonia. Delirious mania is clinically important owing to the potential for diagnostic confusion and good response to ECTs.
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PMID:Electroconvulsive therapy in the treatment of delirious mania: a report of 2 patients. 2115 54

Together with increase of population of elderly people, there is an increase of the number of hospital admission for emergencies, especially for elderly people. Serbia shares this need for Acute Geriatric Units (AGU). The National Programme of Health Care of Elderly People Improvement is planning to open the Geriatric Ward in every regional general hospital in Serbia. But in cities with several hospitals, there is a waste need for geriatric ward capable of taking acute care. So, there is a need for geriatric wards in Serbia nowadays. The main targerts for AGU should be: the comprehensive geriatric assessment, prevention of development of worsening of delirium, decubital wounds, incontinence, improving mobility and early planning of discharge. The multidisciplinary team, which includes physicians, nurses, physiatrist and social worker, is the best solution for getting this target day by day. Thus, one of the distinctive features of Acute Geriatric Units should be comprehensive geriatric assessment, the prevention of geriatric syndrome and early planning of discharging the elderly patient.
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PMID:Acute geriatric units. 2150 6

A prospective two year study of consecutive admissions (n=984) to a psychiatry ward revealed that the incidence of temporary urinary incontinence in psychiatric patients without delirium or dementia was 1.63% (n=l6). When compared with controls (n=64) the incontinent patients were more often psychotic, gave a history of childhood enuresis and a past history of temporary incontinence during psychosis. Compared with psychotic controls (n=26), incontinent patients (n=16) had been exposed to a greater variety of treatments and were hospitalized for longer periods.
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PMID:Urinary incontinence in acute psychosis. 2174 17


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