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Research ArticlePraxis

Optimizing delirium assessment, management, and prevention

DIMS-PLUS5 framework

Sean Goldhar and Chris Frank
Canadian Family Physician December 2022; 68 (12) 897-898; DOI: https://doi.org/10.46747/cfp.6812897
Sean Goldhar
Family physician practising in care of the elderly in the Division of Geriatric Medicine at Queen’s University in Kingston, Ont.
MD CCFP(COE)
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Chris Frank
Family physician specializing in care of the elderly and palliative care at Queen’s University.
MD CCFP(COE)(PC) FCFP
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    Table 1.

    Overview of the DIMS-PLUS5 framework

    DELIRIUM TRIGGERSASSESS FOR …
    DrugIntoxication or overdose, withdrawal, or deliriogenic side effects due to the following: alcohol, cannabinoids, recreational drugs, sedatives or benzodiazepines, anesthetics, anticholinergics or antihistaminergics (eg, dimenhydrinate, diphenhydramine, antispasmodics, muscle relaxants), antidepressants, antipsychotics, anticonvulsants, narcotics (including those causing opioid-induced neurotoxicity), steroids, dopaminergics (eg, levodopa and carbidopa combination), digoxin, lithium, and drugs containing heavy metals or toxins
    InfectionBodily infection, such as respiratory infection, urinary tract infection, cellulitis, and bacteremia
    MetabolicMetabolic triggers such as hypoxia, hypercarbia, hyperglycemia, hypoglycemia, hematologic abnormalities (eg, anemia, hypereosinophilia), electrolyte abnormalities (eg, sodium, calcium, magnesium, phosphate), renal failure, hepatic failure, thyroid or pituitary or adrenal dysfunction, and acid-base abnormalities
    Structural and systemsNeurologic factors (eg, stroke, encephalitis or encephalopathy, intracranial hemorrhage, tumour, head injury, seizure or nonconvulsive status epilepticus), cardiopulmonary factors (eg, shock, hypertensive crisis, respiratory failure, acute coronary syndrome, arrhythmia, heart failure, pulmonary embolism), and any other acute medical or surgical event
    PainPoorly controlled pain
    Liquids and solidsDehydration and malnutrition, including macronutrient and micronutrient deficiencies (eg, thiamine and vitamin B12) and restrictive diets
    Urine and bowelsUrinary retention and constipation
    SensesUncorrected vision, hearing, or communication deficits
    SleepPoor sleep habits (eg, disrupted sleep, napping)
    SettingDisruptive or unfamiliar environment, lack of orientation devices, absence of natural day-night cues, social isolation, or lack of family presence
    StasisRestraints (including immobilizing equipment such as intravenous lines, indwelling urinary catheters, tubes, drains) or deconditioning
    StressPsychological distress
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Canadian Family Physician: 68 (12)
Canadian Family Physician
Vol. 68, Issue 12
1 Dec 2022
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Optimizing delirium assessment, management, and prevention
Sean Goldhar, Chris Frank
Canadian Family Physician Dec 2022, 68 (12) 897-898; DOI: 10.46747/cfp.6812897

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Optimizing delirium assessment, management, and prevention
Sean Goldhar, Chris Frank
Canadian Family Physician Dec 2022, 68 (12) 897-898; DOI: 10.46747/cfp.6812897
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