Acute grief with delirium in an elderly: holistic care
AbstractDelirium in the elderly is a challenging and under-recognized problem in the community. Early detection and management improves outcomes and quality of life for the elders with delirium at home.1 Family physicians (FP) play a key role in the assessments, early identification, and management of delirium and in the support and education of patients and their family caregivers.1 Clinical analysis of this case illustrates the bio-psychosocial spiritual model of approach to management of delirium in an elderly patient in the home setting.
Bond SM. Delirium at home: strategies for home health clinicians. Home Healthc Nurse. 2009;27(1):24-34; quiz 35-6.
Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry. 2004;12(1):7-21.
Lixouriotis C, Peritogiannis V. Delirium in the primary care setting. Psychiatry Clin Neurosci. 2011;65(1):102-4.
Life & Health Library. Hall, Geri Richards. Acute confusion in the elderly; 1996.
Young J, Inouye SK. Delirium in older people. BMJ. 2007;334(7598):842-6.
Wheeler-Roy S, Amyot BA. A field manual. Grief counselling resource guide. New York State Office of Mental Health. 2004.
Clinical guidelines for the care and treatment of older patients with psychiatric co-morbidity in a general hospital setting (Revised 2005). Isle of Wight, NHS.
Hirao K, Ohnishi T, Matsuda H, et al. Functional interactions between entorhinal cortex and posterior cingulate cortex at the very early stage of Alzheimer's disease using brain perfusion single-photon emission computed tomography. Nucl Med Commun. 2006;27(2):151-6.
Gleason OC. Delirium. Am Fam Physician. 2003;67(5):1027-34.
Nadeau JW. Families making sense of death. Thousand Oaks, CA: Sage; 1998;10(4):289.
Welshons JE. Preparing for our own death. Awakening from grief. Finding the way back to joy. Manawao, Hawaii: Inner Ocean Publishing; 2003. p. 159.
Wolfet AD. “Companioning vs. treating: beyond the medical model of bereavement caregiving - Part 3”. The Forum Newsletter. Association of Death Education and Counselling; 1998.
Meagher DJ. Delirium: optimising management. BMJ. 2001;322(7279):144-9. Purchas M. Guidelines for the diagnosis and management of acute confusion (delirium) in the elderly. Royal Cornwall Hospitals, NHS Trust. 2005.
Breitbart W, Marotta R, Platt MM, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153(2):231-7.
William JW. Grief counselling and grief therapy. A handbook for the mental health practitioner. 4th ed. New York: Springer Publishing; 2009. p. 108-42. Coping with grief and loss. helpguide.org.
Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669-76.
Bayne JR. Management of confusion in elderly persons. Can Med Assoc J. 1978;118(2):139-41.
Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-8.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98.