What is delirium, and how does it differ from other memory issues, such as dementia?
Dementia is a chronic, progressive condition that leads to a decline in cognitive function. It is permanent, and the causes are still being studied. There are various types of dementia, each affecting individuals differently and requiring different management and treatment approaches.
Delirium, on the other hand, is best described as a sudden onset of confusion. It can develop rapidly and last for days, weeks, or even months. Delirium is commonly caused by an underlying issue, such as an infection, a reaction to medication, or even a change in environment. People with dementia are at a higher risk of developing delirium, and they can experience both conditions simultaneously.
How common is delirium in older people?
Delirium is relatively common among older Australians, with 10-18% experiencing it at the time of hospital admission, and an additional 2-8% developing it during their stay.
What are the signs and symptoms of delirium that families should be aware of, and what are the risks?
Delirium can manifest in different ways. In some cases, individuals may become highly agitated, confused, anxious, unaware of their surroundings, or even experience hallucinations. This type is known as hyperactive delirium and carries a high risk of falls, accidents, and potentially aggressive behaviour due to fear or paranoia.
Alternatively, some patients may appear especially drowsy and lethargic, sleeping for long periods and becoming unresponsive, which is referred to as hypoactive delirium. The risks associated with this type include inadequate nutrition and hydration, which can exacerbate delirium, as well as the development of pressure injuries due to prolonged immobility.
What are the main causes or triggers of delirium in hospitalised patients, especially among older persons?
From my experience, the most common cause of delirium in older patients is surgery. The combination of anesthesia, medications, and the unfamiliar hospital environment can be overwhelming for the body and mind, leading to confusion. While many people may feel a bit disoriented upon waking from surgery, older adults, especially those over 65 or those with pre-existing dementia, are at higher risk of experiencing prolonged delirium. Other common triggers include infections, particularly urinary or respiratory infections.
What strategies or interventions have you found most effective in preventing or managing delirium in the hospital setting? How can family members or friends help?
Managing delirium in a hospital setting often involves creating a supportive environment. Hospitals can be disorienting places, with a constant rotation of unfamiliar staff and complex medical jargon. Having familiar faces around can greatly help reorient patients and provide comfort and advocacy. It's also beneficial to ensure that patients have activities or distractions to keep them engaged, especially when family members can't be there.
Patience is key when managing delirium. Treating the underlying cause, such as using antibiotics for an infection, is essential, but recovery takes time and is not always linear.
From a nursing perspective, managing patients with delirium focuses on mitigating risks like falls, pressure injuries, and accidents. This might involve strategically placing patients in rooms based on their risk profile and optimising the room environment to keep them as safe as possible until their delirium resolves.
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