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ABSTRACT
Acute confusion is a common complication of hospitalization in the elderly that impacts on both the use of health care resources and the functional status of individuals. Providing optimum nursing care for these patients depends on three factors: 1) the nurse's ability to differentiate acute confusion from other common conditions in the hospitalized elderly, chiefly dementia or depression, 2) the nurse's ability to identify factors contributing to this condition, and 3) the implementation of interventions to minimize the effects of these factors on the patient. This article differentiates the clinical features of acute confusion from those of depression and dementia, and discusses the use of the Functional Consequences Theory, developed by Miller (1990), as a framework for nursing assessment and management of care for elderly patients with this condition. The functional consequences theory framework assists the nurse to identify risk factors associated with the development of acute confusion in the hospitalized elderly. Further it guides the development of interventions to minimize the effects of this condition in this population. The use of this framework in the clinical setting is illustrated through a case study.
As the population ages, the elderly comprise an ever increasing proportion of patients in the hospital. Acute confusion is a common complication of hospitalization for the elderly, with a documented incidence as high as 60% (Inouye, 1991). Acute confusion is associated with increased morbidity, increased mortality, increased length of hospitalization and increased intensity of nursing care. In addition, there is a higher rate of institutionalization for elderly patients who develop acute confusion while in the hospital (Inouye, 1991; Lipowski, 1983; Weddington, 1982; Williams, Ward, & Campbell, 1986). Therefore, acute confusion can be linked with higher cost and increased use of health care resources.
Acute confusion can also impact on the independence and quality of life of an elderly individual. The functional status of the individual may be permanently compromised. Although this is recognized by nurses, the current nursing care and management of patients with acute confusion often has little effect on improving patient outcomes for the acutely confused individual. Providing optimum care for these patients depends on three factors:
1) the nurse's ability to differentiate acute confusion from other common conditions in the hospitalized elderly, chiefly dementia and depression,