Category Archives: Delirium

Satori in the quicksand, the dimishing returns of a hospital admission

Thus, one doctor might say ‘chest infection’ another ‘bronchitis’ another ‘pneumonia’ and a fourth, ‘chest clear, probable urine infection.’

Anxious Jew Redux, Professor Ian Robertson & Blindboy

Doctors are great at diagnosing or assigning diagnoses. It is something that makes many of them very happy. It provides the doctor with certainty, a finite box in which to insert their patient and to focus treatment – antibiotics, pain killers or anti-depressants. (I am sure there is a dopamine release every time a doctor signs a prescription).

Florence Nightingale, Florence Synagogue, Dali and palpitations

‘Diagnosis – Florence Syndrome’

‘Treatment – avoid visiting Florence and/or trips to art galleries. Watch more TV’

Hospital at home, virtual wards and turning care in the community on its head

The doctor calling the ambulance rationalises their actions, ‘I don’t know what will happen to their chest (NB not ‘Albert’, but his chest – a lapse into pathology and medical-speak

The cost of loneliness (Roubles, dollars or robots?)

One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.

Bob Ross, Happy and Unhappy accidents (healthcare and filler-TV)

I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.

Shady Towers, Social Care, Nora and Whitey on the Moon.

The PM announced a rise in NI tax this week. I understand this is to offset some of the damage they have done to the NHS over the past decade. Fantastic. (And yes, Whitey is still on the moon).

If I told you I’m good, you would probably say I’m boasting & Teamworking

We want to be associated with the best – the best team, country, organisation.

Others don’t really care.

Some see the whole of the moon.

Others Brigadoon.

Function versus behaviour

Nothing works with Florence, distraction, diversion, joking, cajoling, all the old tropes fail. You have to accept that Florence isn’t eating and leave her alone.

Pressure ulcers (bedsores) & PCHC

I was recently involved in the care of a patient who developed a pressure ulcer. Behind this seemingly innocuous sentence lurks a whole raft of issues, concerns and aspects of modern healthcare. More surprisingly perhaps, I have spoken with several doctors who believe that pressure ulcers, their care, treatment and avoidance are not a medicalContinue reading “Pressure ulcers (bedsores) & PCHC”

How long until I die? (Locked down and out in 2020)

Often old men and women will seek human contact, particularly when feeling isolated – and when I reciprocate with my gloved hand (that they don’t appear to notice as being anomalously purple or blue) we are able to make contact, to connect.

Covid, my brain and the computer interface

Thanks Jane for allowing me to continue today’s blog; that was about the ways in which Covid has forced a change in my behaviour (likely, yours too) which in turn has led to changes in my brain. It is along the lines of the blog I wrote ages ago after reading a Stephen King bookContinue reading “Covid, my brain and the computer interface”

Charles-Bonnet Syndrome and other thoughts about physical and mental illness

Out optic blind-spots continuously adapt to provide us with a seamless sense of reality, only becoming real when we reverse into a wall that we didn’t see.

Broken sleep & Coronavirus (Bruce Lee, the philosophy of time and space and this week)

Getting rid of the routine allows people to focus on what is important. (Bruce Lee said this in the 60’s – ‘Hack away the un-essential’)

Why an ECHO focusing on human rights in relation to dementia and frailty?

…designed for maximum efficiency of staff and outcomes, not necessarily for the comfort or dignity of patients – we erect a thin curtain between beds and pretend it is sound-proof, for example.

Metrodome Part 2 – agitation in Alzheimer’s disease. (Words and the complex nature of a problem)

You will note this is the opposite of ‘There is no bus to Upton, you are 93, you have dementia, you are in hospital’ approach, which is likely only to worsen the anxiety.

Too negative, too positive, or should I just be quiet? (thoughts on the experiences of people living with dementia in the UK)

Ensure independence, autonomy and the right care and support for people living with dementia (and, yes, older people in general) and the NHS will be fine.

Anticoagulation and possible head injuries in care home residents

Consequently, significant numbers of very frail and older people are transferred to local Emergency Departments following either trivial head injuries or when a head injury is only suspected but not witnessed.

My Job

Mostly, my approach is to consider that we, that is the community services (those outside the acute hospital) can and do support a far broader range of patients than people realise and, when working well together, can care for a significant proportion of the people who otherwise arrive at the door of A&E.

London to Glasgow (cardiologists and frailty)

First, I wanted to mention Neprilysin (and its inhibitor) as it seems to me to be such a cunning piece of high-tech science it should reach this blog. Then I’ll get to the cardiologists!

G. falls over and possibly bangs his head

He was treated with antibiotics and returned to the care home 48 hours later. During his stay he fell twice on the ward; there was an incident with a member of staff which led to him receiving intramuscular Lorazepam.

This afternoon I described death.

In the Yorkshire and Humber Clinical Network for Dementia we are working to increase knowledge and understanding of delirium. This is a state of reversible confusion and disorientation that occurs more frequently in those living with dementia and at times can be mistaken for dementia itself. It isn’t, dementia, that is. It is different, withContinue reading “This afternoon I described death.”

Mental

In Glasgow, if you say somebody or something is mental it means little more than whatever they are doing or saying doesn’t make sense. It isn’t pejorative. In the world of health and care where the stigmas of good and bad still at times run rampant, mental can have a different implication. In general, itContinue reading “Mental”

Today there was a thing about falls.

Old man. In his nineties, he fell. He fell again after arriving in hospital. What to do with him? He wants to go home; we risk and capacity assess. Determine what is right, good or not and let things happen. We tried to get him home. I can tell you something; he’ll fall again. WeContinue reading “Today there was a thing about falls.”

Mindless medicine

It is the way we teach people to blindly follow protocols, pathways and guidance; it is what makes the nurse challenge my wearing a watch but miss all the dirt on the floor or the nurses not washing their hands; it is, to quote Master Lee, staring at the finger and missing the heavenly glory.

Asleep

When was the last time you saw someone you don’t know asleep? This happens to me every day. It is a standard of hospital practice; take a person, young or old, lay them in bed, add the complexities of an acute medical illness and there you go. Asleep. This does not mean that at threeContinue reading “Asleep”

Frailty. No.

I had intended this blog to focus on my planned trip to India in a couple of weeks; readers will have to wait. I want to talk about frailty. For those of you who haven’t kept-pace with my career moves over the past few months, I am now working on the Assessment Unit in RotherhamContinue reading “Frailty. No.”

Collected blogs on delirium 2015 to 2018

How many older people enter hospital and never leave? Are never aware that the paramedics who carry them from their living-room floor will never bring them back; their secrets, mementos, curios, stashed-away in corners only to be discovered by relatives when clearing-out the house after they have moved-on or died.

Blogs, Poems, etc 2017

Rod’s Blogs, Poems, etc.  Table of Contents I search for meaning. 6 ‘Behavioural’ 8 10 Years. 10 10 years. 11 99+. 13 1559 days. 15 A response to Henry. 17 A tale of two times?. 18 Acute. 20 Advance Care Plan, Human Rights & I want what I want 23 alea iacta est 25 AllContinue reading “Blogs, Poems, etc 2017”

Rod’s dodgy drugs top-ten countdown!

This medicine is an old-fashioned anti-depressant, taken in small doses to help pain caused by nerve injury or damage – we call this neuropathic;

UTIs – myths, facts and what Wellbeing Workers need to do – with Helen Sanderson

Dr Rod Kersh’s first blog for us is about Urinary Tract Infections or UTI’s. At Dementia Congress this year, we both heard a presentation about how home carers should respond to issues like UTI’s. It is fair to say that Rod didn’t agree with all that was said, so I asked him to share hisContinue reading “UTIs – myths, facts and what Wellbeing Workers need to do – with Helen Sanderson”

Medically fit – today and tomorrow (3)

You hear this term all the time nowadays, at least, if you work in an NHS hospital, are an inpatient or carer or relative of someone who is occupying a hospital bed. Most often… Are they medically fit? When will they be medically fit? If they are medically fit, have you done the take-home medicines?Continue reading “Medically fit – today and tomorrow (3)”

CRP – aka un-person-centred care

72 hours after admission Nigel has become distressed. Anxious and fearful, he wants to leave the hospital, he can’t understand why we won’t let him go, he feels we are trying to harm him, poison him, deprive him of his liberty.

Dementia – dream state

There is a phrase that is consistent across the fields of dementia, delirium and person-centred care, that is, if you have seen one person with dementia (or delirium, or pain), you have seen one person with dementia (or delirium, etc). Statistics, data, evidence have little to do with the interpersonal one-to-one relationships with people experiencingContinue reading “Dementia – dream state”

At nurse’s discretion

I have been struggling with this recently. Or, at least, some of my team have found this a tricky instruction and have become concerned. I’ll explain the context. Most recently this arose in relation to the care of some of my patients on the ward. You see, when a person passes through the doors ofContinue reading “At nurse’s discretion”

The Hazards of Polydoctory

I started writing this, a little chuffed with myself as I thought I had invented a new word. Alas, someone has beaten me to it, although their meaning is slightly different from the one I intend to use here. In the Encyclopaedia of Ageing and Health edited by Kyriakos S Markides*, Polydoctory is defined asContinue reading “The Hazards of Polydoctory”

Two old men

Stan, Not his real name And Len, Not his real name either, Meet in an unintelligible environment, Clinical, yet, homely, Hotel? Hostel? Hospital? It is all a fog, Stan, because of the progression of his dementia, Len, because of his fading eyesight and general deterioration.   They stand Side by side, Looking out the window,Continue reading “Two old men”

This is me (&you)

Many of you reading this will be familiar with This is me – the person-centred document we have been using in the hospital for the past five or six years. It was originally developed by the Alzheimer’s Society working with the Royal College of Nursing, then, a couple of years ago I got together withContinue reading “This is me (&you)”

Sleep

There is a science of sleep. This evening as I was driving home, I heard Peter White discussing sleep disorders in those who are blind or have significant visual impairment. Unlike our crepuscular cousins, humans are diurnal; we are designed to sleep when it is dark and potter during the day, creating industry, building things.Continue reading “Sleep”

York – somewhere else;

I spent a few hours in York yesterday. I travelled up to present some of the work we have done in Doncaster in relation to Quality Improvement, dementia and delirium (signing, dancing, dog-visits – that sort of thing). Recently, I have been talking about the perpetual Narnia which the government has foisted on the NHS;Continue reading “York – somewhere else;”

Dementia

OK. It is Dementia Awareness Week 2017. Now, until Sunday the 21st. If you want to see what was going-on last year, look here. Today, we released to the world, via You Tube, our most recent film, focusing on Person-Centred Care and Dementia. Just because you have dementia doesn’t mean you stop being you. DementiaContinue reading “Dementia”

Care – Intermediate

We are constantly working to refine the ways that people, particularly those who are older and frail interface with the health and social care system.