Delirium (2)

Today, the Yorkshire and Humber Clinical Network for Dementia releases its new documentation in support of people experiencing delirium and those providing their care.

We have developed these resources with patients, carers, doctors, nurses and therapists to improve care, treatment and, understand some of the challenges posed by delirium within our health and social care environment.

But – what is delirium?

I have run one of the few delirium units in the UK for the past four years. This was the first of its kind in the North of England. We care for predominantly older people, many of whom have dementia, others who do not, who, because of an acute illness, imbalance, falls, trauma or instability become confused and disorientated over hours or days.

Often, we are able to support our patients and help them recover, at other times our patients deteriorate with associated physical and mental decline that is irreversible. Each patient is unique and each experience can be both heart-breaking and inspiring.

Doctors, healthcare scientists and investigators still have a poor understanding of delirium. We know it is often associated with infections or changes to medicine or treatment, we also know that if spotted early, patients can be supported and significant physical and psychological harm avoided.

Delirium has no treatment and its development is difficult to predict although we know that older people are particularly at risk, as are those who have dementia. People living with dementia have ten times the risk of developing delirium compared to others.

Delirium is usually defined as a rapid onset syndrome of fluctuating physical and mental symptoms – with individuals’ sleep, personality and perceptions affected. At times patients hallucinate, they can become hyperactive or passive, depressed or elated.

Frequently early treatment of the primary cause – almost universally (but, often erroneously) blamed on urine infections in older people, can prevent deterioration, at other times the cause is not apparent and the best we can provide is good supportive care.

Supportive care is the cornerstone of delirium management – this means ensuring that any treatable conditions are addressed – pain, constipation, dehydration as well as providing an adequately sustaining environment; one that is free from harm or risk of trauma – in particular for those admitted to hospital this means protection from falls, pressure ulcers or hospital acquired infections, equally, protection from malnutrition, dehydration, loneliness or anxiety can make the difference between recovery and deterioration.

Delirium can affect anyone at any time, young or old, frail or robust.

Most of my patients are older, yet, many of us at some time have experienced similar symptoms – perhaps when ill – the flu of 2015 was particularly bad, for others, injudicious prescription of pain killers or anti-depressants can render us lost within days.

Delirium is a convolution of the senses, where night becomes day and silence deafening. Our perceptions are altered to the extent that the familiar is unrecognisable and, that which might have previously reassured us is terrifying.

I see delirium as an existential disease, one in which our identity, our ability to define or defend ourselves is stripped away.

It is our hope that these resources will help patients, carers and clinicians.

There is much work still to do. Delirium is becoming more common. With increasing numbers of older people living with long-term conditions, and, taking multiple medications, the potential for delirium increases.

Our health and social care staff need to gain a better understanding of this condition – how to identify the early signs, how to diagnose and treat.

If anyone reading this would like more information, please contact: colin.sloan@nhs.net or r.kersh@nhs.net

Dr Rod Kersh is a consultant geriatrician working in Doncaster, specialising in delirium, he is the Yorkshire and Humber Strategic Clinical Network Advisor for Dementia.

Rod maintains a regular blog at www.almondemotion.com.

Network resources can be accessed here – http://www.yhscn.nhs.uk/mental-health-clinic/Dementia.php

Yorkshire and Humber Delirium resources are available at:

http://www.yhscn.nhs.uk/media/PDFs/mhdn/Dementia/Delirium/DeliriumA3Poster-v4.pdf

http://www.yhscn.nhs.uk/media/PDFs/mhdn/Dementia/Delirium/DeliriumLeaflet-v4.pdf

http://www.yhscn.nhs.uk/media/PDFs/mhdn/Dementia/Delirium/DeliriumA6PromptCard-v3.pdf

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