Re: Delirium in older adults. Authors reply

Issue: BCMJ, vol. 59, No. 6, July August 2017, Page 296 Letters
By: Marisa Wan, MD, FRCPC Jocelyn M. Chase, MD, FRCPC

Thank you for your interest in our article.

Thank you for your interest in our article. As you point out, the skillful diagnosis, prevention, and management of delirium is critical to promote the best outcomes for patients at any age, and in all areas of the hospital, including the ICU.

Indeed, ICU-related delirium is an expansive topic for which specific comprehensive guidelines and toolkits exist, delineating the appropriate means of identifying and controlling pain, agitation, and delirium in critically ill patients who may also be ventilated and sedated.[1] These strategies include implementing the ABCDEF bundle mentioned in your letter. However, this is beyond the scope of our article, which focuses on the care of older adults hospitalized on the medical ward.  

Postintensive care syndrome has been increasingly recognized in ICU survivors and constitutes worsened long-term function in one or all of the following domains: cognition, psychiatric health, and physical functioning.[2] Your letter is a helpful reminder that we all bear responsibility for continuing to support and rehabilitate these vulnerable patients once they leave the ICU, giving them the opportunity to regain their best possible functioning. 
—Marisa Wan, MD, FRCPC
—Jocelyn M. Chase, MD, FRCPC

References

1. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263-306.

2. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ conference. Crit Care Med 2012;40:502-509.

Marisa Wan, MD, FRCPC, Jocelyn M. Chase, MD, FRCPC. Re: Delirium in older adults. Authors reply. BCMJ, Vol. 59, No. 6, July, August, 2017, Page(s) 296 - Letters.


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