The 17th March is World Delirium Awareness Day. You might not have heard of delirium, but it affects about 2 in every 10 people admitted to hospital. It can be scary, but is preventable and treatable if you know what to watch out for.
Delirium is a temporary state of mental confusion that starts suddenly. It is actually caused by a physical condition of some sort, such as an infection. Someone suffering from it might not know where they are, what time it is, or what’s happening to them. Medical problems, surgery and medications can all cause delirium.
Delirium can be frightening – not only for the person who is unwell, but also for those around them. In severe cases, the person may hear voices or see things that are not there, or believe that other people (such as hospital staff) are trying to harm them. Current research indicates that around three quarters of people remember their delirium, and all the distressing things that they experienced during it.
Many people believe it is normal for older people in hospital to be confused, but this misconception contributes to the fact that two thirds of delirium cases are misdiagnosed. In fact, although older people are at higher risk, delirium can affect anyone at any age – delirium occurs in 20% of all people in hospital.
People who are at higher risk of delirium include those over 65 years old, who have dementia, poor hearing or vision or have multiple medical conditions, or who are taking multiple medications.
Delirium is preventable. Nurses, Healthcare Assistants and Allied Health Professionals are often best placed to recognise delirium, because they spend more time with patients, and it’s important for everyone to know the signs. If you are worried that your patient or loved one’s behaviour has changed suddenly (for example they seem sleepier, more agitated, more confused, or can’t follow conversations), please THINK DELIRIUM and mention delirium to the doctor.
In Cumbria, the Reach-Out Delirium Service exists to prevent delirium wherever possible. The specialist team, formed in 2017, sees and assesses all patients aged 65 or over admitted to Cumbrian hospitals in an emergency. They screen each person for signs of delirium, and work closely with those patients that are identified as being at risk of developing delirium. The team screen around 2,000 patients every month. Their work has reduced cases of delirium in north Cumbria by over 20%.
Treatment of delirium starts with finding the underlying cause and treating this (for example, giving antibiotics to treat an infection). The most common causes of delirium include infections, dehydration or low salt levels, and liver and kidney problems.
A supportive and calm environment, not moving the person between wards unnecessarily, and ensuring that they eat and drink enough will all contribute to a better and quicker recovery from delirium. It is not recommended to give a person extra medications to combat the symptoms of delirium, unless their behaviour or agitation is very severe and they may hurt themselves or others.
The National Institute for Health and Care Excellence estimates that, on average, suffering from delirium increases someone’s stay in hospital by two days. That may not seem like a lot, but the longer someone stays in hospital the more at risk they are of other infections, and they are away from home and their family.
By preventing and treating delirium more effectively via teams such as the Reach-Out Delirium Service, we can get people home and on the mend quicker. This is better for patients, their family and carers, and also reduces pressure on the NHS.
Like others, the Reach-Out team have faced added pressures and challenges from the COVID-19 pandemic. However, the team are still providing support to all patients with delirium, including those who have tested positive for COVID-19. While visiting restrictions have made things especially difficult, the team have received good feedback about using technology to allow families to video-call their loved ones in hospital, helping them to feel involved and providing some of the therapeutic benefits of seeing each other even though they cannot be in the same room.
In the lead-up to this year’s World Delirium Awareness Day (17th March) the Reach-Out team took part in the Health Education England ‘Marchathon’, a series of daily webinars about delirium. You can watch their presentation to learn more about the work they do.