Delirium – What do you need to know?

Including 12 tips how family and carers help?

Delirium is a common medical problem that can happen when you become physically unwell.  It is also known as “Acute Confusion”.  The symptoms of delirium cause sudden changes in mental functioning and people can appear confused and may appear sleepy or restless or distressed. Delirium is thought to occur 4-5 times more often in a person with dementia. The symptoms of delirium can be mistaken for a person’s dementia getting worse, but it is important to recognise and treat delirium in its own right. Once treated the symptoms usually ease within a few days but can persist for longer periods.

What causes delirium?

There are a large number of possible causes of delirium but some of the most common include urinary tract infection, chest infection, surgery, having a high body temperature, side-effects of drugs like pain killers and steroids, dehydration, constipation or being in an unfamiliar place.  Older Age and multiple medications also increase risk of delirium

What are the symptoms of delirium?

You may:

  • Be less aware of what is going on around you.
  • Be more confused and forgetful, especially in the evening
  • Have difficulty following conversation or to speak clearly.
  • See or hear things which aren’t there (hallucinations)
  • Worry that other people are trying to harm you
  • Have changes in sleeping pattern such as being restless at night and sleepy during the day
  • Feel fearful, irritable or upset

How is delirium treated?

If someone suddenly becomes confused, they need a medical assessment by a doctor urgently.

The person with delirium may be too confused to describe what has happened to them, so it’s important that the doctor can talk to someone who knows the person well.

To treat delirium, you need to treat the cause. For example, an infection may be treated with antibiotics.

12 tips how family and carers help?

It can be reassuring for a person with delirium to have a familiar person with them especially if they need to go into hospital. You can also help by

  • Speaking in a slow clear voice and keeping sentences short
  • Help and encourage the person to take adequate diet and fluids
  • Orientate to time and place. Ensure the person can see a clock and calendar if possible

Pic 1

  • Promote sleep and relaxation
  • Encourage the person to keep mobile
  • Keep lighting appropriate for the time of day
  • Try and have a quiet environment
  • Manage pain and discomfort
  • Make sure that the person is wearing their glasses/hearing aids if required

Pic 2

  • If the person has unusual ideas or hallucinations try to disagree tactfully or try changing the subject
  • Help/encourage the person to maintain activities of daily living such as washing and dressing
  • If the person needs to be cared for in hospital bring in personal items such as photographs, handbags, favourite music or own clothing

Pic 3

Golden Nugget

Delirium is a serious condition if left untreated.  Please seek urgent medical help if you notice a change in presentation

pic 4

I would welcome any hints tips you would want to add to my blog post on delirium?

This week’s blog is by Ruth, an occupational therapist in NHS Forthvalley and also a council member of the Scottish Delirium Association. The Scottish Delirium Association was formed by a group of health professionals working across Scotland. Its aim is to provide a forum for discussion and sharing of best practice. This website provides relevant documents and links.

For further information

Resources and links available at www.scottishdeliriumassociation.com

View Health Care Improvement Toolkit www.healthcareimprovementscotland.org/…/delirium_toolkit.aspx

View a five minute video with Professor Alasdair MacLullich explaining how Scotland is tackling delirium in the care of older people in Scotland, via involvement in Healthcare Improvement Scotland’s programme of work. The video was published on 9 Jan 2014

www.youtube.com/watch?v=BJs3kM_Xnck

@ScotDelirium official page of the Scottish Delirium Association to find out more about their work

Ruth Gardner
Team Lead Occupational Therapist, NHS Forthvalley
@RuthOTDem

I work as an Occupational Therapy Team Lead in a Community Mental Health Team for Older Adults within the Falkirk area. As part of my role I work with people who have newly been diagnosed with dementia and their families. I work closely with my Alzheimer Scotland colleagues and do a joint post diagnostic and singing groups with them. I am also involved in dementia training for Allied Health Professional’s in NHS Forth Valley.

 

 

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12 thoughts on “Delirium – What do you need to know?

  1. Thank you Ruth for this very useful information, it is very helpful.
    As a Carer I do believe believe prevention is so important. In a lot of cases it can be avoided, just by careful monitoring, in particular ensuring a good diet and fluid intake to avoid constipation and Urinary problems. Constipation is a huge factor in delirium and changes in a person’s lifestyle ,diet, inactivity and medication can contribute to this. As an active carer, providing all my husband’s care it is something I monitor on a daily basis, as well as urinary output.
    From a personal point of view, people with dementia need specialist professional care to keep them well, I know from experience how complex caring for someone with advanced dementia is, when delirium can be more common. Sadly that is not available,need to get more professional input in dementia care, to avoid crisis.

    • I would agree that there does need to be more done on prevention and there are so many conditions that can lead to delirium. I have been doing a lot of work with my local Carers Centre raising awareness of this condition and have had very good feedback. Carers have such an important role in identifying acute change as they know the person well. Carers are hopefully feeling more confident in suggesting to GP’s that it could be delirium

  2. I was a carer to my mother for 8 years. I was very aware of changes in her condition and often felt the professionals dismissed my observations on changes in my mothers mental state. When things had deteriorated further I would finally get the help and treatment required. This made the role of carer far more difficult and stressful. I now find myself avoiding going to my G.P with any issues I have for my own needs as I still feel I will be dismissed as a time waster. My mother died three years ago and I worked as an occupational therapist in mental health for thirteen years. My knowledge and experience helped me to cope with my mother but looking after her on my own 24/7 for 8 years was incredibly hard. Carers need far more positive support than they currently receive.

    • Thank you for your comments. So sorry to hear about your mum. Carers have such a hard job. I have found the support of The Princess Carers Trust invaluable. There is work going on via Health Improvement Scotland to improve knowledge and skills around this condition. It is especially complex with someone who has dementia.

  3. Can an antibiotic be prescribed even if specific infection is not identified but the Delirium is the main symptom ?

    • I am not an expert on medication however to the best of my knowledge medical staff would want to know what the underlying cause of the delirium is so that treatment can be tailored to the needs of the person. Antibiotics would only be used infection was suspected. Hope this helps

  4. Firstly, as a patient of Ruth’s with Vascular Dementia, I would like to thank her for all her past help and indeed her continuing help. She has been a rock through some very difficult times for both me and my wife Dee. I enjoyed her piece, and have shared it on Twitter and Facebook so that hopefully my friends will be better able to understand what is sometimes happening to me – and of course to other people in the same boat..

  5. Pingback: Let’s Talk About Dementia – 2015 | Let's Talk about Dementia

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