Display Patient Information Leafelts

Delirium

Date issued: March 2019

For review: March 2021

Ref: A-163/Medical Spec/AS/Delirium v2

PDF:  Delirium [pdf] 439KB

 

What is Delirium?

Delirium is a condition that affects the brain. It is also known as “acute confusion”. It usually affects people who are unwell, therefore is common in hospital.

Delirium can occur in patients of any age but it is more likely in those who are older or have dementia or cognitive impairment (memory problems).

 

How do you know if someone is delirious?

Your family member may be a very different person to the person you know when they are delirious.

Delirium can cause many problems, confusion being the main one. People suffering with delirium are likely to be disorientated, not knowing where they are or the time of day. They may not recognise members of their own family or be able to understand what is going on around them.

Delirium is likely to affect their memory. They may forget things that have just happened, for example that family/friends have just visited. They may develop a distrust of others; have an extreme fear or an unusual behaviour.

Delirium can cause people to be quite agitated, aggressive, they may wander around the ward and be quite restless, this is called hyperactive delirium. However, they can also be more sleepy, which is called hypoactive delirium.

They may have poor concentration, losing track of their conversation or unable to follow instructions (for example when physiotherapists are helping them mobilise). They may also hallucinate (seeing or hearing things that aren't there).

If you are concerned that your loved one may have delirium, speak to a member of the nursing or medical team.

Other issues that can contribute to delirium are:

  • multiple medications
  • withdrawing from alcohol or cigarettes
  • constipation
  • Urinary retention (too much urine in the    bladder)
  • Pain
  • Dehydration
  • Fevers/temperatures
  • Patients with lots of medical problems.

 

What causes delirium?

Unfortunately there isn't just one thing that causes delirium.

Delirium is more common in those who have a serious medical problem, for example an infection, heart attack, or other illness. It is also common in those who have undergone surgery, particularly surgery after a hip fracture, however it can occur with any surgery.

It is also more common in older people and those who are less physically robust but it can occur in younger patients who are unwell. Hearing and sight problems also put patients at higher risk of delirium.

 

How long does delirium last?

Most patients will gradually improve over the course of their hospital stay, once their illness has been treated and their general condition improves.

Delirium is a serious condition and while many people make a complete recovery, some patients will never be back to how they were. It can often unmask underlying memory problems.

Delirium can also impact on their recovery particularly after surgery, potentially not being well enough to rehabilitate with the physiotherapists or having poorer nutrition and hydration as they are too agitated or drowsy.

Unfortunately once a patient has suffered with delirium once, we know that they are more likely to get this again when they are unwell or there are changes in their environment.

 

How can you help your relative who has a delirium?

There are a lot of things you can do to help your loved one who has delirium.  Visiting regularly can help reassure them. Patients can be confused and frightened while in hospital and seeing familiar faces can help.

When you visit your relative, try to encourage them to eat and drink, you can bring in food or drink that they particularly like to help this. Make sure they have their hearing aids in and are wearing their glasses.

Patients are likely to be very confused if they've got delirium, don't argue with them, reassure them.  Remind them that they are in hospital and why they are here, tell them the day of the week and the time of the day.

This is called re-orientation. You could bring some familiar objects or photos from home to reassure them.

 

What are we doing more to help?

Hospital can be a difficult place to be when someone has delirium. There are many ways in which we are trying to help. 

We will keep food, fluid and bowel charts of our patients to make sure they are well hydrated and do not become constipated. At meal times we will encourage them and if needed help them with their meals. We can introduce supplements if required. Relatives and friends are able to come in at meal times to assist as well.  If able, we will avoid bed moves, either between wards or bays. Sometimes we do have to move people around for clinical reasons.

We will review medications regularly to ensure they are appropriate and needed. We will stop any that are unnecessary or that could heighten a delirium. After surgery we will try to ensure their pain is well controlled.

Our colleagues, the physiotherapists will start working with your loved one as soon as possible to enable mobilisation. This helps prevent complications, particularly after surgery, but at any time someone is unwell. This may just be getting someone to sit out in the chair but this alone can help pressure areas and also to prevent a pneumonia (chest infection).

If there is a concern about an infection, this will be investigated and treated.

 

What can be done if your loved one became aggressive?

Our aim is to try and reduce the factors that make people delirious and therefore hopefully reduce the risk of someone becoming aggressive. Unfortunately despite our best efforts this may not be enough.

In this instance, we may ask relatives for their help as often patients are calmer with someone they know around them. We may also, if able get a member of staff to sit with them to reassure them.

If these strategies do not work we may have to use medications to calm your relative down, these are called sedatives. This will only be done if they are a risk to themselves or others.

We will use these medications for the shortest possible period of time and at the lowest dose. To allow us to treat your loved ones in their best interests when they are this agitated we may start a legal document called a Deprivation of Liberty Safeguarding (DOLS). This allows us to legally treat patients in their best interests, including the use of sedatives and also stopping the patient from leaving the ward if they try to do so.

 

Support for relatives and carers

We understand that witnessing your loved one having delirium can be really stressful. The impact on a relative or carer can be significant. If you are worried about your relative, including the plan regarding them leaving hospital after delirium, we recommend you speak to your team of doctors and nurses.

We will try to ensure that our patients, who have suffered from delirium, will get the right level of support when they leave hospital.

Not everyone remembers delirium, but for those that do may find memories distressing or embarrassing. We encourage people who suffered from delirium and their relatives to talk openly about their experiences.

 

Quotes from patients’ relatives:

“My father was always a gentleman. I can not recognise him now; I find it difficult to calm him down and to explain that nobody is trying to harm him in here. The nurse said to me he was up wandering around all night”

“My mum is a total different person after her hip surgery. She is very agitated, trying to pull out all the drips and she is refusing all the tablets. She has mild dementia and is able to recognise family and close friends normally. While she was in the hospital, she didn’t recognise me.”

 

Contact

If you have any questions about delirium please speak to a nurse or doctor on the ward.

For more information about delirium you can visit:

https://www.rcpsych.ac.uk/mental-health/problems-disorders/delirium

https://www.alzheimers.org.uk/get-support/daily-living/delirium?

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