Delirium and ways families can help prevent it

Delirium and prevention

Delirium resultes from an abrupt change in the brain. It causes mental confusion and emotional disruption. It makes it difficult for a person to think, remember, sleep and pay attention. People with delirium may become agitated or aggressive. It can occur at any age but is more common in older adults.

However, it occurs in about one in four older patients in hospital, and families and friends can help to prevent its onset. Even knowing about it can be useful if we have older relatives, including our partners, who may be affected at some time.

NB. This article has not been medically reviewed.

Research shows the prevalence of delirium is even greater in in residential aged-care facilities than in acute care settings because residents tend to have higher degrees of existing baseline cognitive impairment and co-morbidities. It results in unnecessary hospital admission (Buettel et al., 2017

I’ve read several articles about this subject recently. They made me wonder why I didn’t know about it before. But it seems that health professionals also can miss delirium, or else they don’t consider it a serious problem.

Because disturbed mental states occur so regularly in older people in hospitals, nurses and doctors can think that confusion is ‘normal’ during severe illness or after surgery. They may also regard it as a result of pre-existing dementia.

Symptoms of delirium

The symptoms vary from person to person. Some become sleepy and others overactive. Still others experience both states intermittently.

  • Delirium affects the individual’s mind, emotions and sleep patterns.
  • They may experience hallucinations and delusions. These can manifest as agitation or aggression.
  • They cannot concentrate.
  • There’s confusion about where they are.
  • Mood swings occur.
  • Thinking and speaking become unclear. 
  • Short term memory loss can occur.
  • There may be loss of muscle control.

Special risk factors

Any condition that results in a hospital stay, especially in intensive care or after surgery, increases the risk of delirium, as does being a resident in a nursing home.

Causes of delirium

The major contributing factors to the onset of dementia include

  • Being over 65 or with several health conditions.
  • Surgery, anaesthesia and pain.
  • Withdrawal from alcohol and drugs
  • Diseases that cause inflammation and infection, such as COVID-19, urinary tract infection, influenza and pneumonia.
  • Conditions such as a stroke, heart attack, worsening lung or liver disease, or an injury from a fall.
  • Metabolic imbalances, such as low sodium or low calcium.
  • Extreme emotional stress.

The following may contribute to the onset of delirium

Many of the following elements occur precisely because the person is in hospital or needs to be there!

  • Sleep deprivation.
  • Dehydration.
  • Poor nutrition. 
  • Infections like a urinary tract infection.
  • Immobility.  
  • Lack of cognitive stimulation.
  • Hearing and vision problems.

Outcomes

Delirium may prolong recovery time and mean longer in hospital. Longer hospital stays are inconvenient for both patient and family. They also have implications for the health budget and health systems.

The condition may last only a few hours or as long as several weeks or months. If contributing issues are addressed, the recovery time will often be shorter.

The degree of recovery depends to some extent on the health and mental status before the onset of delirium. People with underlying dementia may experience a significant overall and rapid decline in memory and thinking skills. Those in better health are more likely to fully recover.

People with serious, chronic or terminal illnesses may not regain the levels of thinking skills or functioning that they had before the onset of delirium.

Delirium in seriously ill people is also more likely to lead to:

  • General decline in health.
  • Poor recovery from surgery.
  • Need for institutional care.
  • Increased risk of death.

Prevention of delirium

The most successful approach to preventing delirium is to target risk factors which might trigger an episode. Hospital environments present a special challenge. Problems include frequent room changes, invasive procedures, loud noises and poor lighting. Lack of natural light and loss of sleep worsen confusion.

However, if staff promote good sleep habits and help the patient to remain calm and well-oriented they will do better.

Eat Walk Engage

Research in Queensland (Eat Walk Engage) has led to the design and evaluation of a promising prevention program. The simple methods, consistently applied, can reduce the occurrence of delirium among older hospital patients by 47% .

The components of the program are good nutrition and hydration, mobility and exercise and meaningful social and cognitive engagement.

How families can help prevent dementia

Families and friends can play a major part in the prevention of this disorder. They can

  • Advocate to staff on behalf of their loved one. This includes talking about risk factors such as previous episodes and recent hospitalisation.
  • Talk about delirium.
  • Tell staff about the patient’s base-line cognitive functioning and point out changes since hospitalisation.
  • Discuss replacing psychoactive medications in favour of non-medical approaches for anxiety and sleep.
  • Be vigilant and pro-active about the non-use of physical restraints.
  • Ensure that spectacles are clean and available.
  • Ensure that hearing aids have new batteries. Instruct staff about how to insert and use them.
  • Encourage and assist with regular mobilisation if possible.
  • Alert staff to the patient’s preferences for food and drink to encourage better nutrition
  • Encourage good nutrition by being present at mealtimes and assisting with eating.
  • Offer regular small quantities of preferred drinks when visiting.
  • Orientate your loved one frequently to time and place. ‘You’re in (name) hospital.’ ‘You’ve had an operation, and you are getting better.’ ‘It’s six o’clock and the sun is going down.’ ‘It’s the end of April. It’s raining outside.’ ‘Margaret will come to see you tomorrow.’
  • Engage him or her in conversation about everyday life.

Most importantly…

Families provide comfort, communication and connection. They can offer support and assistance no one else can provide. Social connection and engagement – the human elements of care – cannot be underestimated.

Please share this with families and friends, to make the prevention of delirium more widely understood.

Copyright, Maureen Helen 2022
Photo, Maureen-Helen

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4 Comments

  1. Thankyou…I think that this is an important conversation to have. We all need an advocate when hospitalised or in an unfamiliar place when ill or distressed.It reminded me how I felt after a few days in ICU after mitral valve surgery. My daughter was my “voice”

    1. Thank you for your comment, Maureen. I’m a passionate believer in advocacy for people who are ill or distressed or unable to make decisions for whatever reason. Maybe I need to write a blog about that!. I’m glad your daughter was with you when you had cardiac surgery. That must have been very frightening.

  2. Thank you yet again Maureen for a fabulous blog on a matter so important. I always look forward to learning new things from you. Was not aware of ‘delirium’ and this has brought a lot together. Again, thank you.

    1. Glad you enjoyed the post on delirium, Elizabeth. I hope you and others will share this with their families so that more people become aware of the possibility of acquiring delirium as we age and especially as we experience acute illness and undergo surgery. Mx

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