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Today we had a great discussion on wards about #delirium in the elderly.
Delirium is miserable for the patient, can put them at risk for injury, and can lead to longer hospitalization + more complications.
A thread(w/ dogs for no good reason) 1/ #medtwitter #MedStudentTwitter
Delirium is miserable for the patient, can put them at risk for injury, and can lead to longer hospitalization + more complications.
A thread(w/ dogs for no good reason) 1/ #medtwitter #MedStudentTwitter
-It is best to PREVENT delirium, but the following steps are also helpful once delirium starts within the hospital: 2/
1) Review the med list! Eliminate the typical culprits (anticholinergics & benzos) when clinically appropriate. Review Beers criteria for potentially inappropriate medications in older adults: https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15767?casa_token=FAkI55QHgAoAAAAA%3A80o-_SceXSKdlovQouI0uSOm3yiNbgm6zjlK7YhtUHyO6Tgy760IswVij9vqv238QqUvNmkY6fDQ-8Y2/ 3/
2) Re-orient the patient whenever possible - “you are at xyz hospital because of abc, we are the team caring for you” & keep friends/family involved 
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3) If your patient wears glasses, hearing aids, etc- they should be wearing them in the hospital! (Imagine not being able to see for serval days in a strange place
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4) Consider a sleep/wake cycle- at our hospital this means less disturbances overnight. The order also includes instructions to limit daytime napping and keep blinds open during the day, lights off at night 
This is good for stable patients who don’t need vitals overnight! 6/
This is good for stable patients who don’t need vitals overnight! 6/
5) There is some data suggesting that scheduled melatonin at bedtime may reduce rates of delirium, especially in the ICU population. Doses vary, but most recommend starting low in the elderly and working your way up. There is nothing like a good nights sleep
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6) Anti-psychotics should be used 
RARELY for treatment of delirium, typically when the patient is at risk of physically injuring themselves or staff. I’ve typically seen PRN haldol used for this reason. 8/
RARELY for treatment of delirium, typically when the patient is at risk of physically injuring themselves or staff. I’ve typically seen PRN haldol used for this reason. 8/
Please add your tips and tricks for hospital delirium!! 9/ #MedTwitter #MedStudentTwitter #delirium #hospitalmedicine
