- Email: [email protected]
Delineating delirium
DISSECTING ROOM
Books Delineating delirium
Websites
elirium is an indicator of serious illness in the elderly, but is poorly recognised by health-care professionals. The disorder is commonly overlooked because of its diagnostic variability, presentation in multiple contexts, and the different scales used to assess patients. Delirium in
Medline and much more http://gateway.nlm.nih.gov/gw/Cmd The US National Library of Medicine has posted a gateway that allows searching across various specialty databases simultaneously, including Medline, MedlinePlus, OldMedline, LocatorPlus, and DirLine. A search on tuberculosis, for example, yielded 112 948 journal citations, 7533 books/audiovisual materials links, 222 consumer health links, 2526 meeting abstracts, and 38 results from other collections. Users who register (free) can refine their searches and store results in a “virtual locker”.
D
Delirium in Old Age James Lindesay, Kenneth Rockwood, Alistair Macdonald, eds. Oxford: Oxford University Press, 2002. Pp 238. £55.00. ISBN 0 192 63275 2.
Old Age aims to improve recognition of the syndrome and its management. An earlier book published in 1990 by Oxford University Press on this subject, Delirium in the Elderly, was co-authored by two of the current editors. Important advances have occurred in the subject during the past decade, and there has been increased agreement on the diagnostic criteria for the disorder. The editors have succeeded in their aim of defining an agenda for improving the understanding of delirium by assembling what is currently known about the syndrome in a useful format for clinicians, researchers, and interested lay people. Delirium, which has been described since the time of Hippocrates, is a distressing experience for affected individuals, a time-consuming problem for those involved in their care, and an expensive complication for the healthcare system. In the foreword, Sharon K Inouye reports that, in 1994, estimated hospital costs for managing this syndrome in the USA were $4 billion. Increasing age is a major predisposing factor for delirium, so its frequency is expected to increase with the ageing of the population, which will result in an explosion in health-care costs. After reviewing the evidence about the multiple criteria and rating scales applied to the syndrome, Barbro Robertsson recommends that a combination of two or more instruments be used to encompass a brief cognitive test, a diagnostic test to distinguish between delirium and dementia, and a severity scale for delirium. This approach would fulfil most requirements for clinicians and
Mike Sparrow
researchers and allow for comparison across studies. There is currently substantial variation in reported incidence and prevalence rates of delirium, because of differences in the contexts of studies and the diagnostic criteria used. Delirium is a marker of the quality of health care for older individuals. Elderly people with reduced reserves and slowed responses need to be given time to interact with the process of diagnosis and management. However, current policies impede this process by encouraging rapid turnover of inpatients and thereby reducing the time for interactions between patients and health-care providers. The patient’s family also need to be empowered to take part in the partnership of care, since delirium is a distressing health crisis faced by the family unit. Many events faced by an elderly person on admission to hospital are possible precipitants for delirium, and of these, use of medication requires close assessment. A focus of the book is the importance of educating health-care providers about delirium. Detailed information on the current understanding of the neuropathophysiology of delirium is provided, including the role of neurotransmitters, the regulation of acetylcholine and dopamine, and their relative imbalance that may lead to the “final common neural pathway” for the syndrome. These insights also contribute to an overall understanding in brain function. Other issues that are highlighted include variability in presentation of the syndrome and practical issues involved in its prevention and the care of the delirious individual. The social reactions of health-care providers to delirious patients are discussed, and may be used as triggers for in-service training to improve the care of these patients. Delirium in Old Age draws together many areas of current research and closes with a chapter that looks to the future and proposes that delirium is the “ideal subject for interdisciplinary research”. All areas, from basic neuropathophysiology to involvement of family and carers, require further investigation. This useful book will inform and update anyone involved in the care of a frail, elderly person. It is essential reading for geriatricians, trainees in internal medicine, and staff who provide care for these patients in hospital. Annette Britton Geriatric Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20852, USA
THE LANCET • Vol 361 • February 15, 2003 • www.thelancet.com
Library for emergency health care http://www.nelh-ec.warwick.ac.uk The University of Warwick, UK, has launched a “national electronic library for health emergency care”, which is funded by the NHS Information Authority. The health-care professional area is a clinical information and educational resource that can help improve quality of care in emergency departments in the UK and elsewhere. Offerings include: guidance and news on chemical, biological, and radiation agents; a browsable list of evaluated links to all the documents in the emergency care library; learning resources; and links to numerous databases, e-textbooks, and images. Funds for women scientists http://www.lboro.ac.uk/admin/personnel/ athena_web/index.htm The UK’s East Midlands LAWN (Local Academic Women’s Network) has launched a site that aims to help women scientists secure research funding. Included is a bibliography and links to online resources, many of which will be of interest to non-UK researchers. Titanic forensics http://discover.npr.org/features/feature. jhtml?wfId=835398 The US National Public Radio site offers an audio file, Titanic Baby, which describes a 4-year effort to identify a 13-month-old child who died in the Titanic disaster and was buried in Halifax, Nova Scotia. The interview with anthropologist Ryan Parr of Ontario’s Lakehead University provides insights into the work of more than 50 scientists and other researchers who used DNA to trace the child to family members living today. Marilynn Larkin e-mail: [email protected]
619
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Books Delineating delirium
Websites
elirium is an indicator of serious illness in the elderly, but is poorly recognised by health-care professionals. The disorder is commonly overlooked because of its diagnostic variability, presentation in multiple contexts, and the different scales used to assess patients. Delirium in
Medline and much more http://gateway.nlm.nih.gov/gw/Cmd The US National Library of Medicine has posted a gateway that allows searching across various specialty databases simultaneously, including Medline, MedlinePlus, OldMedline, LocatorPlus, and DirLine. A search on tuberculosis, for example, yielded 112 948 journal citations, 7533 books/audiovisual materials links, 222 consumer health links, 2526 meeting abstracts, and 38 results from other collections. Users who register (free) can refine their searches and store results in a “virtual locker”.
D
Delirium in Old Age James Lindesay, Kenneth Rockwood, Alistair Macdonald, eds. Oxford: Oxford University Press, 2002. Pp 238. £55.00. ISBN 0 192 63275 2.
Old Age aims to improve recognition of the syndrome and its management. An earlier book published in 1990 by Oxford University Press on this subject, Delirium in the Elderly, was co-authored by two of the current editors. Important advances have occurred in the subject during the past decade, and there has been increased agreement on the diagnostic criteria for the disorder. The editors have succeeded in their aim of defining an agenda for improving the understanding of delirium by assembling what is currently known about the syndrome in a useful format for clinicians, researchers, and interested lay people. Delirium, which has been described since the time of Hippocrates, is a distressing experience for affected individuals, a time-consuming problem for those involved in their care, and an expensive complication for the healthcare system. In the foreword, Sharon K Inouye reports that, in 1994, estimated hospital costs for managing this syndrome in the USA were $4 billion. Increasing age is a major predisposing factor for delirium, so its frequency is expected to increase with the ageing of the population, which will result in an explosion in health-care costs. After reviewing the evidence about the multiple criteria and rating scales applied to the syndrome, Barbro Robertsson recommends that a combination of two or more instruments be used to encompass a brief cognitive test, a diagnostic test to distinguish between delirium and dementia, and a severity scale for delirium. This approach would fulfil most requirements for clinicians and
Mike Sparrow
researchers and allow for comparison across studies. There is currently substantial variation in reported incidence and prevalence rates of delirium, because of differences in the contexts of studies and the diagnostic criteria used. Delirium is a marker of the quality of health care for older individuals. Elderly people with reduced reserves and slowed responses need to be given time to interact with the process of diagnosis and management. However, current policies impede this process by encouraging rapid turnover of inpatients and thereby reducing the time for interactions between patients and health-care providers. The patient’s family also need to be empowered to take part in the partnership of care, since delirium is a distressing health crisis faced by the family unit. Many events faced by an elderly person on admission to hospital are possible precipitants for delirium, and of these, use of medication requires close assessment. A focus of the book is the importance of educating health-care providers about delirium. Detailed information on the current understanding of the neuropathophysiology of delirium is provided, including the role of neurotransmitters, the regulation of acetylcholine and dopamine, and their relative imbalance that may lead to the “final common neural pathway” for the syndrome. These insights also contribute to an overall understanding in brain function. Other issues that are highlighted include variability in presentation of the syndrome and practical issues involved in its prevention and the care of the delirious individual. The social reactions of health-care providers to delirious patients are discussed, and may be used as triggers for in-service training to improve the care of these patients. Delirium in Old Age draws together many areas of current research and closes with a chapter that looks to the future and proposes that delirium is the “ideal subject for interdisciplinary research”. All areas, from basic neuropathophysiology to involvement of family and carers, require further investigation. This useful book will inform and update anyone involved in the care of a frail, elderly person. It is essential reading for geriatricians, trainees in internal medicine, and staff who provide care for these patients in hospital. Annette Britton Geriatric Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20852, USA
THE LANCET • Vol 361 • February 15, 2003 • www.thelancet.com
Library for emergency health care http://www.nelh-ec.warwick.ac.uk The University of Warwick, UK, has launched a “national electronic library for health emergency care”, which is funded by the NHS Information Authority. The health-care professional area is a clinical information and educational resource that can help improve quality of care in emergency departments in the UK and elsewhere. Offerings include: guidance and news on chemical, biological, and radiation agents; a browsable list of evaluated links to all the documents in the emergency care library; learning resources; and links to numerous databases, e-textbooks, and images. Funds for women scientists http://www.lboro.ac.uk/admin/personnel/ athena_web/index.htm The UK’s East Midlands LAWN (Local Academic Women’s Network) has launched a site that aims to help women scientists secure research funding. Included is a bibliography and links to online resources, many of which will be of interest to non-UK researchers. Titanic forensics http://discover.npr.org/features/feature. jhtml?wfId=835398 The US National Public Radio site offers an audio file, Titanic Baby, which describes a 4-year effort to identify a 13-month-old child who died in the Titanic disaster and was buried in Halifax, Nova Scotia. The interview with anthropologist Ryan Parr of Ontario’s Lakehead University provides insights into the work of more than 50 scientists and other researchers who used DNA to trace the child to family members living today. Marilynn Larkin e-mail: [email protected]
619
For personal use. Only reproduce with permission from The Lancet Publishing Group.