Incidence and risk factors

The prevalence of delirum in medically and surgically ill patients is 11 to 16 per cent and the incidence varies between 4 and 31 per cent ( W.i.s.e a.n.,d Gia.y 1..9.94). The highest incidence is found in the surgical ICU, followed by the coronary care unit and medical and surgical wards ( Lipowski 1990). Several risk factors for the development of delirium have been identified.

1. Elderly patients tend to develop delirium more frequently than younger patients, most likely as a result of pre-existing medical conditions (including impaired brain function and the frequent administration of numerous medications).

2. A history of brain damage (e.g. stroke, dementia), drug dependency, or AIDS increases the risk of delirium.

3. Postcardiotomy and burn patients are particularly prone to delirium. The prevalence of delirium after cardiac surgery is about 32 per cent and seems to be correlated with several factors (e.g. time on bypass, decreased cardiac output, embolic events, and poor nutritional status as indicated by low levels of albumin) (Smithand Dimsdale 1989). The incidence of delirium in burn patients is approximately 18 to 30 per cent; it increases with age and with the severity of burns.

Psychosocial and environmental factors, particularly sleep deprivation, have not been closely linked to an increased risk of delirium. Morbidity and mortality

Delirium is often defined as a reversible and relatively short-lasting impairment of brain function. In fact, the majority of delirious patients recover without observable sequelae, but the exact percentage is unknown (Lipowski 1990). Patients in drug withdrawal states may develop seizures. Some patients fail to recover from the acute confusional state, progress to stupor or coma, and die.

Delirium and agitation increase the risk of complications (e.g. decubiti and aspiration pneumonia) and tend to prolong the length of hospital stay. A substantial number of elderly patients who develop delirium as in-patients (22 to 76 per cent according to different studies) die during their stay in hospital; about 25 per cent of delirious hospitalized patients die within 6 months of discharge (Wise...and...Gra,y 1994).

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