Confusion in elderly patients

Confusion in elderly patients Confusion is prevalent in individuals over  the age of sixty. In older adults, confusion can be a symptom of dementia, delirium, psychoses, or other mental disorders such as major depression. The reduction in cognitive ability may remain for a short amount of time, or it may be a progressive and chronic condition. Depending on the severity of the confusion, it can be classified as: reversible or irreversible

(Espino et al.,1998).

Causes of confusion:

Reversible confusion can be caused by metabolic disorders, medications, infections, vitamin deficiencies, thyroid dysfunction, and pressure in hydrocephalus. Thus, upon treatment of the underlying disorder, confusion can be eliminated (Espino et al.,1998). On the other hand, causes of irreversible confusion can be Alzheimer’s disease, infection due to the human immunodeficiency virus, and damage to the central nervous system (Espino et al.,1998).

Factors of confusion:

Dealing with confusion in the elderly can prove to be challenging due to biological aging, complex comorbidities, cognitive impairment, lack of detailed history on presentation, several constraints on assessment, proper evaluation, and because some patients live alone (Gupta, et al.,2019). Biological aging can be further defined as decreasing functional reserves, progressive loss of adaptability, and the decline in the ability to recover from a mental or psychological injury. In addition, aging can lead to a multiplicity of diseases including confusion (Gupta et al.,2019). 

Screening tools for confusion:

Screening tools for confusion are useful because confusion can occasionally be clinically unrecognized. These tools include:

• The most widely used tool is the Confusion Assessment Method (CAM), but it requires specific training and relies on the understanding of inattention.
• 4AT test. Will test attention, alertness, acute history, and Abbreviated Mental Test 4 (AMT4). In this test, no understanding of inattention is required (Gupta et al.,2019)

Examination:

Physical examinations aid with differentiating between psychiatric and neurologic disorders in elderly individuals who present with confusion. The physical evaluation assesses the patient’s level of orientation and arousal. Patients with a clouded consciousness and a lack of alertness are more likely to have confusion (Gupta et al.,2019).

A full examination should review the following areas:

1. Consciousness level
2. Neurological examination
3. Evidence of alcohol abuse 
4. Evidence of pyrexia

Preventive measures in elderly patients:[j1] 

Physical exercise and adequate metabolism

• Adequate nutrition
• Adequate fluid intake
• Check the appropriateness for drug dosage and its combination with other drugs.
• Avoid rapid cessation of drugs or substances on which the patient is dependent (Gupta et al.,2019).

Medical treatment:

Some following measures help treat confusion in elderly patients.

• Correct biochemical derangements
• Where possible, reducing or withdrawing the drugs causing confusion 
• [j2] 
• alleviation of exacerbating symptoms
• Communication with relatives
• Avoiding major tranquilizers when possible (Gupta et al.,2019).

In conclusion, aging can result in several reversible and irreversible changes in the human brain which may lead to confusion. Proper diagnosis and treatments of confusion are crucial and should be carried out with the help of healthcare providers.

References

Gupta, S., & Gupta, A. (2019). Confusion in the older patient: a diagnostic approach | GM. Retrieved 14 June 2021, from https://www.gmjournal.co.uk/confusion-in-the-older-patient-a-diagnostic-approach

Espino DV, Jules-Bradley AC, Johnston CL, Mouton CP. Diagnostic approach to the confused elderly patient. Am Fam Physician. 1998 Mar 15;57(6):1358-66. PMID: 9531917.

[j1]make sure to not start with just a list. What are we preventing? confusion?

[j2]from what i recall we said this was a test not treatment…