Acute confusional states in the elderly

Abstract

One hundred and twenty-two consecutive patients admitted to the psychogeriatric ward of Moisio Mental Hospital because of confusion, agitation, and disturbance of the sleep wakefulness cycle are discussed. The duration of confusion before referral varied between one day and one month and 65 of the patients met the DSM-III criteria for delirium. The mean age of the group was 73.7 years and the range 60-87 years. For 88 patients the index admission was their first; 34 patients had previous admissions. One third of the patients were admitted from their homes and two thirds from other hospitals, health center wards and federal homes. Patients were treated in a locked 25-bed psychogeriatric ward and the length of hospitalization varied between 2 and 395 days (mean 30.5 days). During the hospital period, medical and neurological examinations and a battery of medical investigations were also carried out: blood studies, urinalysis, CSF examination, chest and skull X-ray, ECG and EEC Diagnoses of the etiologically significant illnesses and causes of the development of confusion based on the history, psychiatric interview, physical examination and laboratory findings, the most common causes were life changes, acute cerebrovascular accidents and infections. 105 patients received neuroleptics in addition to other medication indicated by their physical condition. In 88 cases high-potency neuroleptics were used and the mean daily chlorpromazine-equivalent neuroleptic dose was 143 mg and the range 20-650 mg. After the hospital care half of the patients were discharged back to their homes, less than a half to other hospitals, health center wards and federal homes; 7 patients died during the index admission. □ Acute confusion, dementia, psychogeriatrics.