Even in hospital it can be difficult for delirium to be spotted and diagnosed. This is another reason to tell staff if you notice a change in the person you care about. Three clinical subtypes of delirium have been identified. [16] Potter J, George J; Guideline Development Group. The prevention, diagnosis and management of delirium in older people: concise guidelines. Clin Med. 2006 May-Jun;6(3):303-8.

It can be a consequence of low oxygen level, infections, kidney or liver disease, or even a sign of withdrawing from substances – for example if someone is used to smoking but has been in hospital for a long time. If you have a loved one with delirium, it can feel scary or overwhelming to see them act confused or not like themselves. Delirium is a condition that healthcare providers are better prepared to recognize and manage. They also have a wide range of techniques they can use to try to prevent it. More importantly, you can also help prevent delirium in a loved one. Delirium indicates a widespread disruption in brain activity. That means there are many possible symptoms of delirium. It’s also important to remember the symptoms may look different from one person to the next. It can also fluctuate. Delirium can often get better during the day and worse as nighttime approaches, which is why this condition sometimes gets the incorrect name of “sundowning.” Francis J Jr. Delirium and acute confusional states: Prevention, treatment, and prognosis. https://www.uptodate.com/contents/search. Accessed Sept. 19, 2022. not moving the person unnecessarily – either within and between hospital wards, or into hospital if delirium is being managed at home.While delirium is generally considered reversible, studies suggest that delirium symptoms can last for weeks to months following onset. [13] Roche V. Southwestern Internal Medicine Conference. Etiology and management of delirium. Am J Med Sci. 2003 Jan;325(1):20-30. They can also be easily distracted, so will have difficulty taking in information or understanding what is being said. They may be forgetful and feel disorientated. They may have difficulty making judgements, have incoherent speech (rambling), or be unable to recognise spaces or shapes.

The most frequent presentation in critical care is when patients move between the two states – from agitated, hyperactive behaviour to becoming sleepy and unresponsive. Don’t try to help a loved one with delirium unless a healthcare provider (especially your loved one’s physician or nurse) tells you it’s OK to do so. Following the guidance of trained healthcare providers is key to keeping both you and your loved one safe from harm. Healthcare provider prevention techniques We can often tell that my father is getting a urinary infection because he starts to get slower and becomes quiet and withdrawn. He also sleeps much more.” Agitation or restlessness Zayed Y, Barbarawi M, Kheiri B, et al. Haloperidol for the management of delirium in adult intensive care unit patients: a systematic review and meta-analysis of randomized controlled trials. J Crit Care. 2019 Apr;50:280-6.People with delirium often act very differently than they do under ordinary circumstances. A common statement or feeling among people who see a loved one with delirium is, “That’s not the person I know.” Visit. Social interactions with family, friends and other loved ones can be a major help in preventing delirium. If your loved one is in a hospital or medical facility setting, be sure to follow the rules and guidelines for visiting, too. Phone or video calls are also helpful for those who can’t make it in person.

Despite its frequency, delirium is frequently under-recognised given the fluctuating nature of symptoms and an overall under-appreciation of its significance by healthcare providers. Moreover, delirium has also been associated with elevated risks for functional and cognitive decline, poor rehabilitation potential, institutionalisation, and re-hospitalisation. [1] Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med. 1999 May;106(5):565-73. Kishi T, Hirota T, Matsunaga S, et al. Antipsychotic medications for the treatment of delirium: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry. 2016 Jul;87(7):767-74. Delirium is often a very frightening experience for both patients and relatives, and one that can be difficult to talk about. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression. HADS consists of 14 items with seven statements for each sub scale: HADS Anxiety (HADS-A) and HADS Depression (HADS-D). Every statement has four possible choices (on the Likert scale ranging from zero to three), and the maximum score per sub scale is 21 points. 24 Preoperative HADS-D scores >4 points were used to indicate an abnormal test result. 25Vision and hearing loss later in life. Your senses, especially vision and hearing, help you know what’s happening around you. Loss of those senses reduces your brain’s ability to use cues from the outside world, making it easier for delirium to develop. Vandewalle G, Schmidt C, Albouy G, et al. Brain responses to violet, blue, and green monochromatic light exposures in humans: prominent role of blue light and the brainstem. PLoS One. 2007;2:e1247. Other neurotransmitters implicated in the pathophysiology of delirium include noradrenaline, serotonin, gamma-aminobutyric acid, glutamate, and melatonin. Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104:216–23.

Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics. 2000;56:645–6. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Medications you take. Some medications can increase your risk of developing delirium, even when used as prescribed. Because of this, healthcare providers often avoid prescribing certain medications to people 65 and older or those with a history of certain conditions. Polypharmacy, taking more than five medications at a time, also increases your risk.

The beers of delirium

It could be a side effect of taking certain drugs, or immobility, constipation, dehydration, or sleep deprivation – or simply the experience of being in hospital. Usually, patients have multiple drivers for their delirium rather than just one thing. Ghaeli P, Shahhatami F, Mojtahed Zade M, Mohammadi M, Arbabi M. Preventive intervention to prevent delirium in patients hospitalized in intensive care unit. Iran J Psychiatry. 2018;13(2):142-147. PMID: 29997660 When a person leaves hospital after delirium, they may need more support than usual. They may be at higher risk of falls and need some changes in the home to make sure that their environment is safe. Attention. The ability to stay focused or maintain focus is impaired with delirium. A person in the early stages of dementia remains generally alert. Someone with dementia often isn't sluggish or agitated. As you get older, you are more likely to have delirium. People who are over 80 years old and have been diagnosed with some type of dementia are particularly at risk. However, delirium can happen in younger people as well, especially if they are critically ill or after surgery. Symptoms of delirium