What is Delirium

Delirium is a common problem in hospitals and long-term care homes. It makes it hard for people to communicate, eat and sleep. It also causes pain and stress.

Medical professionals assess delirium with patient interviews, cognitive tests and observations. They avoid medications that may cause delirium (such as psychoactive drugs and anticholinergics). They provide pain management and optimize mobility.

Causes

Delirium is very common in hospital and care home settings, especially in older people. It can be hard for staff to recognize and respond to, particularly if someone looks quite old or has a diagnosis of dementia in their chart. This is why loved ones, family and friends - and professional carers - are vital in recognising and describing these changes.

Some things make you more likely to get delirium, like having mood disorders or a history of delirium in the past. Having a chronic illness that puts strain on your body, and having lots of different medicines can also increase the risk. Losing your senses (sight and hearing) increases the risk because they help you to use cues from the outside world to tell you what is going on around you.

A change in mental state that is sudden and doesn't improve with time - or that gets worse - is usually a sign of delirium. It is often better explained by a medical problem, such as infection, or an illness or injury that affects brain function, such as stroke or traumatic head injury.

Symptoms

Delirium can cause problems with your memory, thinking skills and attention. You might also have hallucinations and changes in your emotions or behavior. Symptoms can come and go over minutes or hours. They may be more severe at night.

You might be irritable and agitated, or quiet and withdrawn. You might have rapid changes in your consciousness, with a disorganized thought pattern, or you might speak quickly and loudly with slurring or using neologisms. You might be unable to understand what people are saying to you or they may misunderstand your words.

Health care professionals will look at your symptoms and medical history, as well as other tests to work out what caused the delirium. This might include blood samples or a chest X-ray. They might also give you medicine to help with your delirium. It’s important to have regular visits from friends and family. You can also make phone or video calls if you can’t visit in person.

Treatment

The first step in treating delirium is to address the causes or triggers. Health care providers do this by identifying and reversing illnesses or problems that are contributing to the delirium, adjusting medications and improving the environment.

Medications that precipitate or perpetuate delirium should be stopped or decreased. Pharmacists can help by performing medication reconciliation, reviewing prescriptions and over-the-counter drugs for potential sedative or psychoactive effects and reporting concerns to the appropriate clinician.





People with delirium should be given fluids to stay hydrated, and they should be kept calm and comfortable. They should be encouraged to move around early (under medical guidance) as this can help reduce delirium and improve their ability to use cues from the outside world. Family members and friends should visit frequently, as this has been shown to be helpful. Restricting the use of physical restraints has also been shown to improve delirium. This is particularly important to prevent falls, hospital acquired infections, bedsores and functional decline in people who are prone to delirium.

Prevention

Delirium costs health systems a lot of money, negatively impacting patient outcomes, distressing loved ones and caregivers and increasing hospitalization days. However, many of the causes of delirium are preventable.

The key is maximizing functional reserve capacity to buffer the stressors that lead to delirium. This involves minimizing risk factors:

Pharmacists can perform medication reconciliation and ensure that patients are not receiving medications that may precipitate delirium, including psychoactive drugs with anticholinergic effects. personal alarms for seniors Physicians and nurses can assess for pain, provide appropriate and adequate opioid therapy, and minimize tethering effects (such as IV and oxygen lines, urinary catheters and physical restraints) by evaluating the person’s ability to move on a regular basis.

Family members can help by orienting the person to the time (clocks and calendars) and providing regular sensory input to reduce boredom. Encouraging the person to move around early in treatment, under medical guidance, can also lower their risk of delirium. Encourage use of hearing and vision aids, and regularly assess for pain.