Delirium is a common problem for the elders from the acute setting to the long-term care facilities. The prevalence of delirium was 1% to 2% in those aged 65 years and older, rising to 10% in those aged older than 85 years, and rising further to 22% in elderly patients with dementia with prevalence ranging from 1.4% to 70% depending on diagnostic criteria in long-term care. Additionally, a study reported that the prevalence of delirium superimposed on dementia ranged from 22% to 89% of hospitalized and community populations aged 65 years and older with dementia. Nevertheless, 65% of doctors and 43% of nurses could not identify the delirium problems of hospitalized elderly people.
Purpose
The purpose of this study is to develop the conceptual model of delirium in the elderly people.
Methods
The authors applied three keywords of delirium, elderly, and evidences-based nursing into Chinese CEPS, Cinahl, Cochrone Library systems and identified 15 evidences-based studies from 2008 to 2017.
Results
The results identified five sub-concepts under the delirium as silence, acute, confusion, aggressive, repeat in the circular way. The contributing factors of delirium for the elders included individual, medical, combine, environmental, and health care providers factors. There were three factors in the individual factors including underline risk, physical disorder, and social deficiency. In the underline risk, aging, substance abuse, psychiatric illness, development neuro-inflammation, neurodegenerate, cerebrovascular dysfunction, and others were in the individual factor. Surgery, inappropriately managing the balance of O2 /Co2 , hemodynamic, and cerebral de-saturation were in the physical disorder. Social deficiency included alone and isolation. Multiple medications and sedation were in the medical factor. Dementia, depression, cognitive dysfunction were in the combine factor. The environmental factor included the emergency and ICU as well as the transferred from one unit to the other one. Nursing interventions for the health care providers included paying attention, identified orientation, taking the appropriate restraint, and validate assessment tool.
Conclusion and Implications
Based on the conceptual model of delirium in the elderly people, healthcare providers could concentrate on controlling the contributing factors of delirium for the elders as well as following the evidences-based nursing interventions for the delirium elders. In the long run, the delirium elders from acute to chronic settings could be managed appropriately; therefore, the population of repeated delirium for the elders who were predicted to become dementia might be reduced. Eventually, the quality of care for the elderly delirium could be improved by the healthcare providers.
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