The management of delirium in the older adult in advanced nursing practice
Delirium is a term used to describe an array of symptoms that indicate a disruption in cerebral metabolism, a condition that is often under-recognised, leading to delayed interventions. The condition is a common cause of older adults presenting in hospital, with significant morbidity and mortality associated with increased length of stay. A case study is used to illustrate the use of a diagnostic algorithm for older adults presenting with delirium to an advanced nurse practitioner (ANP)-led service. The clinical decision pathway provides four differential diagnoses, using the case study to put the decision-making process in context. The article demonstrates the ability of the ANP to practise at a high level of expertise as an autonomous practitioner and shows how the pathway supports the nurse to reach an accurate diagnosis. It shows that prompt and accurate diagnosis of delirium in older adults is crucial to avoiding the complications and cognitive decline associated with the condition.
Research shows that delirium, independent of age, dementia, illness severity and functional status, predicts multiple adverse outcomes for older adults, including morbidity and mortality, alongside increased length of hospital stay (Pendlebury et al, 2015; Welch et al, 2019). For the advanced nurse practitioner (ANP) evidence-based practice (EBP) is paramount to providing the best possible care outcomes for the older adult.
This article sets out a logical approach to obtaining a comprehensive clinical history using the most effective clinical screening tools to provide accurate diagnosis of delirium in the older adult. It presents a short case study that is followed by the application of a diagnostic algorithm, to illustrate the role of the ANP. Algorithms are typically developed from evidence-based clinical guidelines and facilitate the transfer of research to practice, providing nurses with as step-by-step approach to make effective decisions (Jablonski et al, 2011)
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