Delirium and acute problematic behavior in the long-term care setting.
Delirium and acute problematic behavior in the long-term care setting.
American Medical Directors Association - Professional Association
Summary,
GUIDELINE OBJECTIVE(S)
* To improve the quality of care delivered to patients in long-term care facilities
* To offer care providers and practitioners in long-term care facilities a systematic approach to recognizing, assessing, treating, and monitoring patients with delirium and acute problematic behavior
TARGET POPULATION
Elderly residents of long-term care facilities with delirium or acute problematic behavior
INTERVENTIONS AND PRACTICES CONSIDERED
Recognition/Assessment
1. Identification of the patient's problematic behavior and altered mental function including delirium (assessment of symptoms, medical history, medications; use of Confusion Assessment Method [CAM] instrument and diagnostic criteria for delirium)
2. Assessment of individual risk factors for problematic behavior and delirium
3. Determination of the urgency of the situation and the need for additional evaluation and testing
4. Identification of the cause(s) of problematic behavior and altered mental function
5. Assessment of medical illnesses and conditions that can affect behavior such as medication-related adverse consequences, fluid or electrolyte imbalance, infections, acute renal or hepatic failure, head trauma, myocardial infarction, stroke, and others
6. Use of laboratory tests including electrolytes, blood urea nitrogen (BUN), glucose, creatinine, complete blood count (CBC), chest x-ray, urinalysis, electrocardiogram (EKG), serum vitamin B12 level, and others
7. Consideration of possible psychiatric illnesses such as psychosis, mood disorders, and personality disorders and dementia-related causes
Management/Treatment
1. Initiation of a care plan for treatment
2. Provision of symptomatic and cause-specific management
3. Administration of medications such as antipsychotics, antidepressants, cholinesterase inhibitors and memantine, anticonvulsants, and anxiolytics
Monitoring
1. Monitoring and adjustment of interventions as indicated
2. Reviewing the effectiveness and appropriateness of medications
3. Prevention, identification, and addressing of any complications of the conditions and treatments
MAJOR OUTCOMES CONSIDERED
Benefits and risks of treatment
