Here’s a guest post on delirium by a couple of leaders in the American Delirium Society (American Delirium Society) by James L. Rudolph, MD and Marianne Shaughnessy, PhD, CRNP. Dr. Rudolph and Dr. Shaughnessy are both on the American Delirium Society (ADS) Board of Directors.
James L Rudolph, MD
VA Boston Geriatric Research, Education, and Clinical Center Past President, American Delirium Society
150 S. Huntington Ave
Boston MA 02130
Baltimore VA Geriatric Research, Education, and Clinical Center
Secretary, American Delirium Society
10 N. Greene Street (BT/18/GR)
Baltimore, MD 21201
Evidence is rapidly building that delirium is associated with mortality, functional decline, and increased costs. Despite the increased literature, delirium remains poorly recognized both clinically and as a research priority. The American Delirium Society (ADS) formed to raise awareness, establish research collaborations, and develop educational initiatives. In the following paper, we propose mechanisms to expand these domains.
In the 1980s, pioneering work in delirium found that physicians miss 33-66% of delirium in hospitalized adults. (1, 2) Later studies found that nurses also experience difficulty and recognize only 31% of patients with delirium.(3) Additionally, the misnomers, (examples: sundowning, psychosis, dementia, encephalopathy, etc) continue in clinical practice among specialists. Clearly, there is a strong need to increase delirium awareness among patients, healthcare professionals, and family members. Additionally, the pending age wave, with its accompanying anticipated increase in the incidence of cognitive impairment, add to the imperative to answer some of the underlying questions about delirium. Finally, changes in healthcare financing with the Affordable Care Act will demand that cost effective approaches to quality care take priority in research and clinical environments.
Prior work has found that research funding for delirium lags behind the funding of other, equally, morbid mental health disorders. For example, 2011 NIH funding for delirium was $14.5M compared with funding for depression ($1,166M) , dementia/Alzheimer’s Disease ($819M), and schizophrenia ($577M).(4) The lack of available research funding hampers efforts to identify a defined pathophysiologic mechanism for delirium, and effective pharmacological and non-pharmacological treatments. As a result, there is incredible need for increased research collaboration and innovation in delirium. The ADS serves as a network to develop these collaborations, present and discuss preliminary research findings, and develop pathways for delirium drug approval, as well as, increasing awareness of drug development.
To achieve the clinical and research aims related to delirium, there is also a need for an educational strategy. While the primary focus of such a strategy must be clinicians who provide front-line care, there is also a need to educate researchers, policy makers, and all healthcare providers about delirium. The ADS is developing educational materials for health care professionals as well as for patients and families about the course and recovery of delirium by leveraging its multidisciplinary membership. The Institute of Medicine (IOM) report on developing a geriatric workforce (2008) suggested that “geriatric competence needs to be improved through significant enhancements in educational curricula and training programs”. (5) Capitalizing on opportunities to introduce delirium into pre-licensure curricula and post-licensure competencies would be critical for the ADS.
From a clinical standpoint, there is great need for quality improvement and models not only to improve detection but also to improve hands on clinical care. Time effective strategies that improve the recognition, prevention, and treatment are vital. Delirium currently takes a tremendous toll, both in healthcare and human costs in the form of poorer physical and functional outcomes and increased mortality. The American Delirium Society has as its mission to promote and lead scientific inquiry, sharing knowledge about delirium: its presentation, prevention, and management, using research, education, quality improvement, advocacy, and implementation science in order to minimize the impact of delirium on patient’s short and long-term health and well being, and on the health care system. Despite the fact that delirium has long been an identified phenomenon, remarkably little is understood in terms of mechanisms, effective preventions and treatments.
The ADS welcomes membership from all healthcare disciplines to join the cause.
Check out our website at American Delirium Society.
1. Levkoff SE, Besdine RW, Wetle T. Acute confusional states (delirium) in the hospitalized elderly. Annu Rev Gerontol Geriatr. 1986;6:1-26.
2. Inouye SK. Delirium in hospitalized older patients: risk factors and recognition. J Geriatr Psychiatry Neurol. 1998;11(Fall):118-25.
3. Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM, Jr. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med. 2001 Nov 12;161(20):2467-73.
4. NIH RePORT: Estimates of Funding for Various Research, Condition, and Disease Categories. Bethesda, MD: National Institutes of Health; 2011 [cited 2012 June 15]; Available from: http://report.nih.gov/rcdc/categories/.
5. Retooling for an aging America: building the healthcare workforce. In: Medicine Io, editor. Washington, DC: National Academies Press; 2008.