Delirium in older adults in critical care is associated with poor outcomes, including
longer stays, higher costs, increased mortality, greater use of continuous sedation
and physical restraints, increased unintended removal of catheters and self-extubation,
functional decline, new institutionalization, and new onset of cognitive impairment.
Diagnosing delirium is complicated because many critically ill older adults cannot
communicate their needs effectively. Manifestations include reduced ability to focus
attention, disorientation, memory impairment, and perceptual disturbances. Nurses
often have primary responsibility for detecting and treating delirium, which can be
extraordinarily complicated because patients are often voiceless, extremely ill, and
require high levels of sedatives to facilitate mechanical ventilation. An aggressive,
appropriate, and compassionate management strategy may reduce the suffering and
adverse outcomes associated with delirium and improve relationships between nurses,
patients, and patients’ family members.