Cause of acute delirium in elderly patients with dementia
Many older people, with and without dementia can be all of a sudden be affected by delirium, which is defined as acute sudden confusion. When an elderly patient becomes confused very suddenly, it is important to look at all possible underlying causes. Mayne et al. (2019) state that â€œnon-specific symptoms, such as confusion, are often suspected to be caused by urinary tract infection (UTI) and continues to be the most common reason for suspecting a UTIâ€. Delirium in the elderly is usually associated with lengthened hospital stays, complexed care, institutionalization, along with high mortality rates, difficulties for the caregivers and increased healthcare costs. Signs and symptoms associated with UTIs in the elderly include confusion or delirium, increased lethargy, blunted fever response, new-onset incontinence, as well as anorexia (Rodriguez-Manas, 2020). There are various risk factors associated with UTIs in a male patient. Some of these include prostatic hypertrophy, diabetes, or both, which can lead to high post-void residuals.
A confused patient who has recently become delirious should be investigated for the source of the delirium. Krinitski et al. (2021) state that â€œthe diagnosis of UTI requires not only confirmed bacteriuria but also the presence of genitourinary symptoms, which often cannot be reliably confirmed in the many delirious individuals who are unable to adequately express themselvesâ€. However in this case study, it is know that the patient is experiencing urinary incontinence, which further justifies the diagnosis of UTI.
A urinary analysis and culture are both highly suggested for this patient. When bacteria from the UTI has been detected in the elderly, providers usually â€œconsider behavioral or mental changes, including delirium, as non-urinary manifestations of UTI, especially in patients with cognitive impairment, from whom local urinary tract symptoms are often difficult to obtainâ€ (Krinitsky et al., 2021). Depending on the bacteria that is growing, different types of antibiotics may be used.
Males experience disturbed normal voiding mainly due to their benign prostatic hyperplasia (BPH). Due to their enlarged prostate, â€œgeneration of a retrograde turbulent urine flow, enabling the ascension of uropathogens to the bladder and eventually into the prostate, which explains the high frequency of prostatic involvement in males with UTIâ€ (Smithson et al., 2019). As such, fluoroquinolones such as cipro can be used in order to treat the UTI with adequate prostatic diffusion.
It is also important to note that normal voiding in the elderly patients is the first line of defense against UTIs. In a patient with dementia however, it may be difficult to trust that they will void regularly and that they take their medications properly and at the right time. Nothing that the patientâ€™s MMSE score dropped from 18 to 12, this patient has progressed from moderate to severe dementia. Because of this change of cognition, it would be more beneficial and appropriate for this patient to be admitted to the hospital for IV antibiotics. A referral to the emergency department is therefore warranted.
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