89 © Springer International Publishing AG 2018 A.T. Isik, G.T. Grossberg (eds.), Delirium in Elderly Patients, https://doi.org/10.1007/978-3-319-65239-9_8 Y. Savran, M.D. • B. Comert, M.D. (*) Department of Medical Intensive Care Unit, School of Medicine, Dokuz Eylül University, Izmir, Turkey e-mail: bilgincomert@yahoo.com 8 Approach to the Elderly Patient with Delirium: The Intensive Care Specialist’s Perspective Yusuf Savran and Bilgin Comert Delirium is accepted as an acute organ dysfunction in intensive care units (ICU). There is an acute deterioration in consciousness and cognition with fluctuations, and main characteristics of delirium are defined by the American Psychiatry Association in the DSM-5 (American Psychiatric Association 2013). Delirium in the elderly is a frequent condition in ICU. It can be seen in 60–80% of the patients on mechanical ventilation support, while this proportion is lower (20–50%) in the patients not on mechanical ventilation (Ely et al. 2001a, b; Dubois et al. 2001; Girard et al. 2008; Pandharipande et al. 2007, 2008). Delirium has marked negative effects on short- and long-term results of the patients. The patients with delirium in ICU are at increased risk of undesirable conditions like prolonged mechanical ventilation, catheter removal, self-extubation, and need for physical restraints (Girard et al. 2008; Micek et al. 2005; Shehabi et al. 2010). Additionally, delirium causes longer hospital stays, more treatment costs, increased inhospital mortality risk, and increased necessity of nursing home care after discharge (Shehabi et al. 2010; Ely et al. 2001a, b, 2004; Ouimet et al. 2007; Thomason et al. 2005; Milbrandt et al. 2004; Inouye and Charpentier 1996). The common misconception is that delirious patients have either hallucination or delusion. These symptoms are not necessary for diagnosis. Other frequent symptoms seen in patients with delirium are sleep disturbances, abnormal psychomotor activity, and emotional disturbances (e.g., fear, anxiety, depression, apathy, euphoria, anger). Patients with delirium may be agitated (hyperactive delirium) and calm or lethargic (hypoactive delirium) or may fluctuate in between these two types. While hallucina- tion and delusions frequently accompany hyperactive delirium, hypoactive delirium generally is characterized with confusion and sedation (Barr et al. 2013).