sf_delirium - BreeJohnstonMDMPH CaseStudy s Mrs.M....

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Delirium in the Elderly Bree Johnston MD MPH UCSF Division of Geriatrics  Primary Care Geriatric Lectures
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DIVISION OF GERIATRICS, DEPARTMENT OF MEDICINE PRIMARY CARE GERIATRIC LECTURE S Case Study Mrs. M. is a 70 year old woman with a history of thalamic  CVA, bipolar illness, chronic pain, and osteoarthritis.  She  takes tylenol with codeine, valproate, lithium, conjugated  estrogens with progesterone, and aspirin.   Two months ago,  her daughter died unexpectedly, and she has been more  depressed.  One week ago, she became agitated and  uncooperative.  She was seen in the ER, where labs and  CXR were normal.   A consulting psychiatrist recommended  clonezapam.
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DIVISION OF GERIATRICS, DEPARTMENT OF MEDICINE PRIMARY CARE GERIATRIC LECTURE S Despite the clonazepam, she worsened, and became uncontrollable at home. She went back to the ER, where she had a fluctuating level of consciousness. CBC, renal panel, and CXR were normal. An EKG showed a LBBB (old) with slight ST changes from last EKG. Troponin level was 2.9. On further questioning, the patient admitted that she has some shortness of breath 5 days prior. The admitting team concluded that her delirium was due to ischemia/infarction. She was treated with aspirin and beta blockers and did well. A persantine thallium showed a large fixed inferior defect and no reversible disease.
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DIVISION OF GERIATRICS, DEPARTMENT OF MEDICINE PRIMARY CARE GERIATRIC LECTURE S Presentation of MI in the Elderly AGE # CP SOB Neuro >65 387 19% 20% 33% 74 87 59% 22% 16% 76 777 66% 42% 30% >62 110 22% 35% 18% Pathy 1967 Tinker 1981 Bayer 1986 Aronow 1987
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DIVISION OF GERIATRICS, DEPARTMENT OF MEDICINE PRIMARY CARE GERIATRIC LECTURE S Atypical Presentations “Well Elderly” “Frail elderly” % with atyp. present 25% 59% Type of Presentation Delirium 32% 61% Falls 37% 9% Immobility 5% 6% Functional decline 26% 19% Other 0 5% Jarrett et al. Arch Int Med 1995
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DIVISION OF GERIATRICS, DEPARTMENT OF MEDICINE PRIMARY CARE GERIATRIC LECTURE S Learning Objectives Recognize that delirium is a common presentation of  disease in the elderly Recognize that delirium is associated with adverse  outcomes Know how to distinguish between delirium and other  diagnoses (dementia, depression) Identify risk factors for delirium and strategies for risk  reduction Discuss management strategies, recognizing the limitations  of current data
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Definition “an acute disorder of attention and cognition” ( de lira   “off the path”) Standard definition not use until 1980 with  publication of DSM III Other terms used include  organic brain syndrome,  metabolic encephelopathy, toxic psychosis, acute  mental status change, exogenous psychosis,  sundowning
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sf_delirium - BreeJohnstonMDMPH CaseStudy s Mrs.M....

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