More than one-half
of all intensive care
unit (ICU) days are
incurred by adults
65 years and older.1
Unfortunately, once admitted to an
ICU, older adults are at high risk for
delirium. Often referred to as “acute
cognitive dysfunction,”4 delirium is
a common and serious geriatric syndrome
in the ICU. Formally, delirium
is defined as an acute but temporary
state of fluctuating levels of consciousness
and pervasive impairment in mental, behavioral, and emotional
functioning.5 The manifestations can
be extremely upsetting to patients,
patients’ families, and nursing staff.
Delirious patients may experience
visual and auditory hallucinations,
are impulsive, are often disoriented,
and often have self-injurious behaviors.6
These behaviors potentially
increase the risk for poor outcomes.
Nurses play an essential role in
the management of delirious, critically
ill older adults. Nurses are often
the interdisciplinary team members
who first notice that an elderly patient
is experiencing a change in mental
status; determine whether the patient
is experiencing other indications of
distress such as pain, anxiety, or
dyspnea that may cause or contribute
to the behavioral changes; and intervene
by using the best available evidence
to promote the comfort, safety,
and welfare of the patient. This
process is extraordinarily complicated
because many older adults are
voiceless due to their critical illness,mechanical ventilation, and the sedative
effects of medications used in
the ICU to facilitate care.7 Furthermore,
critical care nurses are practicing
in an environment where
health care providers are just beginning
to fully appreciate the prognostic
importance of delirium.8
In this article, we review current
evidence pertinent to delirium in
critically ill older adults and describe
pharmacological and nonpharmacological
approaches nurses can use to
manage the distressing physical, psychological,
and emotional manifestations
of delirium in older patients.