by Jay Luxenberg, MD 

As many as half of all nursing home admissions have either subsyndromal or full-blown delirium. If they manage to avoid having delirium during their first six months in a SNF, still the majority of residents will demonstrate delirium symptoms at least once over the rest of their long term stay in a SNF. In SNFs, nurses identify delirium only about half the time it is present. The is no data on how often assisted living staffs identify delirium. Although nursing home staffs have been shown to be open to delirium reduction programs, no such program has shown proven efficacy in reducing delirium incidence, duration or severity. At our CALTCM meeting I will review the data from other settings – acute hospitals, ICUs, etc, that we are forced to extrapolate from to make decisions about delirium management in the skilled nursing. I will also review the AGS Clinical Practice Guideline for Postoperative Delirium in Older Adults and other recent clinical practice guidelines that can help us in the absence of site-specific research. Just for the fun of it, we will also discuss strategies to minimize delirium occurrence in hospitals by using newer sedative agents compared to usual practice. As always, the aim is to give you useful take-home information to improve the care you provide in long-term care environments.

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