Delirium

 

There must be a psychological reason to explain why some people more readily respond by saying yes when asked to do something, compared with others who either reply with an outright no, an evasive, why, what… Let me see, or an oblique, Look at that chaffinch over there.

I fall into the former category every time.

Yes.

I said yes when Nic asked me whether I would like to run a webinar discussing delirium on the 15^th of March, to celebrate World Delirium Day.

It could be that the pathways in my brain are unstable, live-wires with inadequate insulation. There you go. Spark.

I was woken this morning at 530 when my phone buzzed with a tweet from a well-known professor of deliriumology who was re-tweeting about the webinar.

You see, the problem is, although I pretty-much live delirium – I have spent more time talking to people with delirium or the relatives of people experiencing delirium than most, I still am not entirely sure I know much about it.

This is because no one really knows or understands. (Except perhaps the professor).

You see, we don’t understand why some people are more likely to become delirious compared with others, that is, why some are more susceptible. People who have dementia, for example, are many times more at risk of developing delirium secondary to relatively minor insults – changes in environment, pain, dehydration, or, constipation, whereas others, require far greater physiological upsets – septicaemia, major surgery, trauma or, an adequate dosage of LSD or Psilocybin.

That is less perhaps of concern, as the more any of us learn , the less we all realise we know.

I should probably offer some reassurance; we do have an idea about some aspects of delirium, at least, we know what works – or at least, what probably works most of the time, although it is so complicated that what works for one person is likely to not work for another.

There are however common themes:

   Person-centred care – I have yet to encounter a patient where treating them as an individual, providing them a sensitive ear, caring touch or individualised plan of care has been harmful.

   Keeping people safe – you can’t argue that when people have delirium they are vulnerable, and, equally, if those vulnerable people injure themselves – fall, trip or otherwise experience harm, they are likely to have a less favourable outcome.

   Ensuring hydration and adequate nutrition – this is, avoiding dehydration or malnutrition, hunger or thirst, these can contribute to a worsening of the delirium.

   Involving family and friends – ensuring that loved-ones have as much access as desired to their delirious mum, dad or grandparent. You are more likely to trust your son or daughter than a stranger in a uniform.

   Sleep – disturbance of the sleep-wake cycle is often a key component of delirium – this as part of my translation of the hospital at night (sometimes trendily referred to as H@N), which in my experience is more like, Night at the Museum, with drowsy, confused patients, fewer staff, strange shadows and the additional impact of sleeping tablets. Establishing good sleep at night and wakefulness by day – that is having adequate stimulus, entertainment and engagement during can all help.

There are many more what we call ‘multi-component interventions’ some of which work, some of which do not, to help a person who is delirious.

We still haven’t figured-out which medicines work for delirium. It seems that although many drugs can contribute to its development, (pain-killers, sleeping tablets, bladder medicines) we haven’t found a pill than can prevent it or even stop it happening.

If only delirium were more like stroke, heart attacks or pneumonia. We could provide the aspirin, thrombolysis or antibiotics and wait for nature to run its course. It is not that simple.

And amidst all this I have offered to say a few words about delirium on the 15^th. You are welcome to tune-in; the link is here.

If you can’t or don’t sign-up to listen, I hope what I have written will help to explain some of the morass. It is what keeps me busy. That, and all the other things I am too mentally slow to respond with anything other than ‘yes’.