Deliriumpromoting

Deliriumpromoting is a term used to describe factors that increase the risk or severity of delirium, an acute, fluctuating disturbance of attention and cognition. Delirium is common in older patients, especially during acute illness or after surgery, and it signals substantial vulnerability to brain dysfunction.

Medications with delirium-promoting properties are a major category. Drugs with anticholinergic effects, such as diphenhydramine, oxybutynin, and many antihistamines; sedatives and hypnotics like benzodiazepines and zolpidem; opioids and certain corticosteroids can contribute to delirium, particularly in older adults or when used in polypharmacy.

Medical and metabolic disturbances strongly contribute: infections, electrolyte imbalances (for example hyponatremia or hypercalcemia), hypoxia, dehydration, organ failure, malnutrition, and metabolic derangements such as liver or kidney dysfunction. Acute multimorbidity and sensory or sleep disruption also act as delirium-promoting factors.

Iatrogenic and environmental factors play a role. Hospitalization, ICU stays, sleep deprivation, pain, immobilization, sensory impairment or overload, invasive devices, and complex care regimens can precipitate delirium in susceptible individuals.

Pathophysiology involves disrupted neurotransmission, notably relative cholinergic deficiency and dopaminergic excess, neuroinflammation, and network dysfunction. Predisposing factors include advanced age, preexisting dementia, functional impairment, and baseline cognitive vulnerability; delirium risk accumulates with polypharmacy and severe illness.

Preventing or mitigating deliriumpromoting factors is a cornerstone of delirium management. This includes careful medication review to minimize anticholinergic burden and sedatives, treating underlying illness, ensuring adequate hydration and nutrition, promoting sleep and orientation, and mobilization. When agitation occurs, antipsychotics are used cautiously and only after addressing reversible causes.