(Originally written March 2020 for Alzheimer Scotland AHP Dementia blog as a basic introduction to delirium for AHPs.)
Do you know what delirium is? You’d be perfectly forgiven if the answer is “No” and yet Allied Health Professionals have a clear role to play in the prevention of this deadly condition. And it is deadly, take a look at some of the alarming facts from the Scottish Delirium Association below.
Did you know that…..
- Delirium is a serious medical emergency.
- It is highly distressing for the person experiencing it and their family.
- 20-30% of people on a medical ward may have it.
- 10 -50 % of people who have had surgery may develop it.
- The risk of delirium increases in people who are older, or have a dementia diagnosis, take multiple medications, have sight or hearing difficulties, dehydration, hip surgery, constipation, sleep deprivation, or are in pain.
- The mortality rate for someone admitted to hospital with a delirium is between 10-26% (Science Direct).
- People who have had a delirium are twice as likely to die in the following 12 months as someone who has not (Science Direct).
- Upto 33% of delirium cases can be prevented. So let’s get busy!
Shocking and frightening, so what exactly is delirium???
Delirium used to be known as acute confusional state. Anyone can get it but people with dementia are more likely to experience it and vice versa. There is a link between those who have had a delirium and the onset of dementia. It can be caused by many different things, infections, reaction to medications, pain, constipation, dehydration and there are several different types. People may see and hear things that aren’t there and become very anxious, agitated and even aggressive. Relatives remarking “That’s just not my mum, my mum would never normally behave like that!” is often heard when a person has a delirium. The delirium can go when the symptoms are treated but it can also last even after the causes have been treated and even reoccur.
Still a little confused? This clip by Dr Sophia Bennett and Dr Mani Krishnan and the North Tees Liaison Psychiatry Team is one of my favourites and I think really helps explain delirium. Click the link: https://www.youtube.com/watch?v=BPfZgBmcQB8
As an Allied Health Professional what is your role in the prevention of delirium? The IDEAS Team in NHS Dumfries & Galloway have produced this poster to summarise current evience on best practice in managing delirium and to help staff think about their role in preventing and managing delirium. How does this map onto what you can offer as an AHP? Promoting physical and meaningful activity, good nutrition and hydration, maximising the senses and creating positive environments and communication are our specialities!
This poster is another useful one, produced by The Regional Geriatric Program of Toronto.
Allied Health Professionals have a definite role to play in preventing and managing delirium. It’s often said, but it is everybody’s business. Delirium Awareness Day this year is March 17th 2021. Below are some useful links that might help any AHPs wishing to get a group together to explore this topic further. Many NHS Boards also have Delirium Champions who may have local resources and your Dementia Nurse/AHP Consultant or local Community Psychiatric Nurse (CPN) will definitely be able to point you in the right direction.
*Since this blog was originally written to introduce AHPs to delirium in March 2020, it has been learnt that delirium may be a symptom of Covid in older adults. Specialist advice on covid and delirium is available from The Royal College of Psychiatrists here:
and The British Geriatric Society here:
https://www.bgs.org.uk/resources/coronavirus-managing-delirium-in-confirmed-and-suspected-cases
Useful CPD Links:
The Scottish Delirium Association has lots of resources for patients, carers and professionals. They also have an active Twitter account @ScotDelirium.
http://www.scottishdeliriumassociation.com/
If you’re a Tweeter The European Delirium Association are also worth following @EDA_delirium.
Think Delirium is a tool kit for professionals, well written, practical and easy to read. It is a collaborative project by Healthcare Improvement Scotland, NES and The Scottish Delirium Association:
For those who can access Turas there are various modules:
A new SIGN Guideline No. 157 was published in 2019:
https://www.sign.ac.uk/our-guidelines/risk-reduction-and-management-of-delirium/
The NICE Guideline CG103 was also updated in 2019:
https://www.nice.org.uk/guidance/cg103
Science Direct has a nice factsheet with links to current research here:
https://www.sciencedirect.com/topics/neuroscience/delirium
The British Medical Journal published this great free printable infographic which is a fabulous ‘at-a-glance’ reminder of the differences between hyper and hypodelirium and a podcast link here:
https://www.bmj.com/content/357/bmj.j2047/infographic
Helen Moores-Poole, Advanced Speech & Language Therapist
SLT Lead, Mental Health and the IDEAS Team (Interventions for Dementia, Education, Assessment & Support).
dghealth 