OASIS Alert

Published on Sat Jun 02, 2007 PDF

Your OASIS assessment may identify the cause.

When the answer to M0560 (Cognitive functioning) shows a patient with delirium, the race is on to find the cause in order to save the patient from a permanent decline or even death. And other M0 questions may point you to the cause.

First step: Start by looking at the "most suspect" causes for the individual, suggests Ann Marie Monahan, a clinical educator in Vancouver who has helped develop educational materials on delirium.

"For example, if the person just had surgery [M0230/M0482], you look at anesthetics, drugs, and pain," says Monahan. A person who is admitted from the hospital may have a low-grade delirium that didn't clear up completely from the hospital stay, she adds. Urinary tract infections (M0510) are also a major cause of delirium. It's probably related to dehydration but not always, she says. Pain (M0420/M0430) and medications (M0780) are other common causes -- or the person's disease process may destabilize, which leads to delirium.

Assessment gem: "Once a person suffers from delirium, there's a high-percentage chance the person will have another episode," adds Monahan. "The ideal is to develop a clear picture of what the person is like when he or she has delirium so you can identify it the next time it occurs."

Get help: Determining the cause of a person's delirium may require further investigation. And that may include "talking to the family to see if the [individual] has had the condition before," advises Rena Shephard, president of RRS Healthcare Consulting in San Diego, CA. You may also have to enlist the assistance of the consulting pharmacist or the physician to order lab tests and do a physical exam, she adds.

Other Possibilities To Look For

Potential but often overlooked causes of delirium include:

• Poor oral health, including diseased gums or a rotted tooth. This "can set up a low-grade infection that leads to delirium," says Monahan.

• Sleep deprivation. Consultant Diane Brown reports a case involving a cognitively intact elderly gentleman who stopped sleeping after he developed post-operative infections. "He'd fall asleep and then have a myoclonic jerk and start hallucinating," says Brown, CEO of Brown LTC Consultants in Boston. The hospital ED diagnosed the problem as severe sleep deprivation. The physician prescribed sleeping medication for the patient, who took it and slept for 24 hours. As a result, the patient stopped hallucinating, says Brown.

• Non-psychoactive medications that you may not think of as causing delirium. For example, because they block acetylcholine, "anticholinergic drugs are a major cause of delirium," says Monahan. "And people with Alzheimer's already have a low amount of that neurotransmitter," she adds. Digoxin is another drug that can cause delirium. "An older person may require a lower blood level of Digoxin," advises Monahan.