Managing delirium in the elderly requires a multifaceted approach that addresses underlying causes, supportive care, and pharmacological interventions when necessary.
Get the full solved assignment PDF of MME-106/As-2 of 2024 session now.
Here are some drugs commonly used in managing delirium in the elderly:
**1. Antipsychotics:**
– **Atypical Antipsychotics:** Drugs such as risperidone, olanzapine, quetiapine, and aripiprazole may be used to manage agitation, hallucinations, and delusions associated with delirium. These drugs have a lower risk of extrapyramidal side effects compared to typical antipsychotics.
– **Typical Antipsychotics:** Drugs like haloperidol or chlorpromazine may be used cautiously in low doses for short-term management of severe agitation or psychosis in delirium. However, they carry a higher risk of adverse effects such as sedation, extrapyramidal symptoms, and QT prolongation.
**2. Benzodiazepines:**
- Benzodiazepines such as lorazepam or diazepam may be used cautiously for the management of agitation or anxiety associated with delirium. However, they should be used sparingly due to their potential to worsen confusion, impair cognition, and increase the risk of falls.
**3. Anticholinergic Medications:**
- Avoid medications with anticholinergic properties whenever possible, as they can exacerbate delirium symptoms in the elderly. Examples include antihistamines (e.g., diphenhydramine), tricyclic antidepressants (e.g., amitriptyline), and medications for overactive bladder (e.g., oxybutynin).
**4. Sedative-Hypnotics:**
- Avoid using sedative-hypnotic medications such as zolpidem or benzodiazepines for sleep disturbances associated with delirium, as they can worsen confusion and increase the risk of falls.
**5. Cholinesterase Inhibitors:**
- Cholinesterase inhibitors such as donepezil, rivastigmine, or galantamine may be considered for the management of delirium in patients with underlying dementia, especially if delirium is thought to be related to cholinergic deficiency.
**6. Melatonin Agonists:**
- Melatonin agonists such as melatonin or ramelteon may be considered for the management of sleep disturbances associated with delirium, particularly in patients with disrupted circadian rhythms.
**7. Non-Pharmacological Interventions:**
- Non-pharmacological interventions should be prioritized whenever possible and may include environmental modifications (e.g., reducing noise, providing familiar objects), reorientation techniques, frequent reassurance and support from caregivers, early mobilization, optimizing hydration and nutrition, and addressing underlying precipitating factors (e.g., pain, constipation, urinary retention).
**8. Multidisciplinary Approach:**
- Delirium management in the elderly should involve a multidisciplinary team, including physicians, nurses, pharmacists, occupational therapists, physical therapists, and social workers, to address the complex needs of the patient and implement a comprehensive care plan.
**Note:**
– Drug therapy should be initiated at the lowest effective dose for the shortest duration possible and regularly reassessed for efficacy and adverse effects.
– Close monitoring for adverse effects, drug interactions, and changes in delirium symptoms is essential during pharmacological management.
– In cases of severe agitation or aggression that pose a risk to the patient or others, temporary pharmacological interventions may be necessary, but these should be used judiciously and with careful monitoring.
Overall, the management of delirium in the elderly should focus on identifying and addressing underlying causes, optimizing supportive care, and utilizing pharmacological interventions when indicated, while minimizing the risks of adverse effects and complications associated with medication use.