Elderly Patients and Population

ICU and Delirium Evidence-Based Project Proposal Patients that are sixty-five years or older account for an average of more than fifty percent of the visitors to the Intensive Care Unit (ICU) and there are a host of known risk factors that are associated with individuals who are among this demographic and many elderly patients are discharged directly to long-term living facilities due to the fact that they are unable to continue to function independently and maintain daily activities (Tang, Tang, Hu, & Chen, 2016).

It is further estimated that approximately one quarter of all of the elderly patients that are admitted to the emergency department display some form of metal impairment related to delirium, dementia, or both, and many hospital departments have made mental assessments for these demographics part of their routine operations (Soryal & al., 2014). Therefore, not only does the prevalence of mental impairments serve as a serious concern for the demographics included in this population, but it is also a major consideration for the healthcare system in general.

Furthermore, this population is also associated with some poor short-term and long-term outcomes which make an ideal target for an interdisciplinary use of evidence-based practices (EBP) to improve the quality of care provided to these patients. For older adults in the ICU, there are a range of complex treatment modalities that can result in deleterious consequences that can affect them for years after they are discharged from inpatient treatments due to their vulnerabilities and often the frailty that is exhibited in both physical and mental functioning (Malone & al., 2014).

For example, some studies have concluded that the prevalence of geriatric syndromes is high and in some cases nearly fifty-percent of the older adult patients exhibited one or more of the symptoms of geriatric syndromes which include conditions such as delirium, insomnia, hearing and vision loss, lower extremity problems, falls, pressure ulcer, urinary incontinence, dizziness, syncope, cognitive impairment, polypharmacy and functional dependence (Tang, Tang, Hu, & Chen, 2016).

Delirium in particular is associated with items such as increased mortality in adult ICU patients, prolonged ICU and hospital stays, and the development of post-ICU cognitive impairments among others (Barr & al., 2013). It is commonly believed that delirium patients need to be hallucinating or delusion in order to fit this diagnosis, however this is not entirely the case. There are several other changes in the severity of mental functioning that can also be associated with delirium such as any reduction of mental clarity, disorientation, or even language disturbances.

Therefore, it is reasonable to believe that many practitioners may miss a delirium diagnosis when it first presents themselves due to the misconception of the requirements to classify various levels of cognitive dysfunction. Therefore, one proposal for an evidence-based practice study may be to study the effectiveness in various delirium assessment tools to help identify and monitor these patients.

There are many instruments that are available and it would be advantageous, for many reasons, to identify which assessment tools function most effectively, especially among patients who are considered high risk for delirium symptoms. Such high risk patients include those who use certain medications such as opioids, benzodiazepines, and propofol among others, have a history of alcoholism, undergo sedation, undergone a coma, and more. Such patients should be automatically assessed and be considered.