[Delirium in the elderly; article for education and training purposes]. / Delier bij ouderen.

In delirium, there is an acute change of consciousness with fluctuations in attention, cognition and perception. Delirium can be provoked by medical conditions, or the use or withdrawal of drugs. Risk factors include older age and cognitive impairment. Delirium is associated with many complications, represents a significant emotional burden for the patient and caretakers, increases length of stay in the hospital, and causes higher health care costs. Non-pharmacological measurements can sometimes prevent delirium, and are essential for its treatment with proven effectiveness. Antipsychotics should be administered only as an exception, not as a rule. Antipsychotics may be of use when the patient puts himself or others in danger, or when he suffers substantially from hallucinations.

[Insomnia in hospital]. / Slapeloosheid in het ziekenhuis.

- Every night in hospitals physicians on night shift are confronted with insomnia among their patients and have to make a decision on prescribing sleeping medication.- The extent to which insomnia is disadvantageous to hospital patients and its effects on clinical outcomes have not been well investigated.- A recent systematic review concluded that it is not known if treatment of insomnia with medication, such as melatonin or benzodiazepines, has a beneficial or a disadvantageous effect on clinical outcomes. This also holds true for non-pharmacological interventions.- The adverse effects of melatonin have not been properly quantitatively investigated. The use of benzodiazepines is related to potentially severe adverse events such as falling, respiratory infections and the risk of addiction.- Until such time that reliable scientific data are available, we advise caution in prescribing sleep medication for patients in hospital.