Risk factors for delirium

Risk factors of delirium can be divided into:

• predisposing factors
  • comorbidities
    • alcoholism
    • chronic pain
    • history of baseline lung, liver, kidney, heart or brain disease
    • terminal illness
  • demographic factors
    • age older than 65 years
    • male sex
  • geriatric syndrome
    • dementia
    • depression
    • elder abuse
    • falls
    • history of delirium
    • malnutrition
    • polypharmacy
    • pressure ulcers
  • premorbid state
    • inactivity
    • poor functional status
    • social isolation
• precipitating factors
  • acute insults
    • dehydration
    • fracture
    • infection
    • ischemia – cerebral, cardiac
    • medications
    • metabolic derangements
    • poor nutrition
    • severe illness
    • shock
    • surgery
    • uncontrolled pain
  • environmental exposure
    • ICU setting
    • sleep deprivation
• delirium-inducing medications
  • high risk
    • anticholinergics - e.g., antihistamines, muscle relaxants, antipsychotics)
    • benzodiazepines
    • dopamine agonists
  • moderate to low risk
    • antibiotics (e.g., quinolones, antimalarials, isoniazid, linezolid [Zyvox], macrolides)
    • anticonvulsants
    • antihypertensives (e.g., beta blockers, clonidine
    • sedatives/hypnotics
    • tricyclic antidepressants
    • low-potency antihistamines (e.g., histamine H2 blockers, urinary and gastrointestinal antispasmodics) (1)

Reference:

• (1) Kalish VB, Gillham JE, Unwin BK. Delirium in older persons: evaluation and management. Am Fam Physician. 2014;90(3):150-8.