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Dispel the Myths – Delirium
October 21, 2009 Centre for Studies in Aging and Health, Providence Care
- Dr. John Puxty
Dispel the Myths Delirium October 21, 2009 Centre for Studies in - - PowerPoint PPT Presentation
Dispel the Myths Delirium October 21, 2009 Centre for Studies in - - PowerPoint PPT Presentation
Dispel the Myths Delirium October 21, 2009 Centre for Studies in Aging and Health, Providence Care Dr. John Puxty Susanne Murphy Definition Delirium is a disturbance of consciousness with reduced ability to focus, sustain, or shift
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Definition
“Delirium is a
disturbance of consciousness with reduced ability to focus, sustain, or shift
- attention. It is a change
in cognition that occurs
- ver a short period of
time and tends to fluctuate over the course of the day.”
(Milisen et al. 2001).
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Delirium
Latin translation: § to be “crazy” or to “rave”
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Personal Experiences
The individual with the delirium might feel: § trapped, in turmoil and/or distressed Caregivers and family might feel: § confused, helpless, distressed, frustrated and/or embarrassed
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Key Features
Change in level of alertness:
§ drowsiness § agitation § poor attention span § wandering § disrupted sleep cycles § easy distractibility
Possible disorientation, memory deficits and hallucinations “Picking” at clothing or non-existent objects It is not always easy to diagnose and/or treat. There may be multiple causes and treatment may not always work the way we hope.
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Delirium is a Medical Condition
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Its common!
It is estimated that when people come into hospital, 10 - 18% of them are delirious and can rise to 20 - 40% during hospital stay Delirium has been found in 40% of individuals admitted to intensive care units Deliriums are common after a surgery As many as 80% of individuals will develop delirium as they near end-of-life
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Risk Factors for Delirium
Dementia Presence of other limitations or illnesses (e.g. vision, hearing, severe illness and/or difficulties in thinking or memory) Dependence in activities of daily living History of depression Use of some medications
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Why do People get Delirium?
A whole bunch of reasons!
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Some of the Reasons…
Infection Withdrawal (benzodiazepines/alcohol) Acute metabolic changes (blood sugar/fluids / electrolytes) Trauma (pain) Not enough oxygen in the blood (hypoxia) Problems with endocrine system (regulation system
- f the body)
Problems with blood flow Toxins/drugs Exposure to heavy metals (mercury, cadmium, lead, arsenic and aluminum)
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The most common Reasons…
Drugs, drugs, drugs, drugs: § prescription, over the counter or over the fence, illegal drugs, alcohol withdrawal Infections Metabolic disturbance: § blood sugar, fluids, electrolytes Systems: § heart, lungs, endocrine Pain
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Poor Prognosis
Mortality rates in hospital: § 10 - 26% for those admitted with delirium § 22 - 76% of those who develop delirium during hospitalization have increased chance of death during the months following discharge) With or without dementia, an independent predictor
- f sustained poor cognitive and functional status
during the year after medical admission to hospital Increases the length of stay and likelihood of admission to long-term care facilities Average increase in cost of care $2,500 per case
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Under-Recognition of Delirium
Research tells us that the rate of unrecognized delirium is as high as 66% Most often delirium is mistaken for: § dementia § depression
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So, what does Delirium look like again …
acute change in mental status AND inattention with fluctuations PLUS disorganized thinking OR altered level of consciousness
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Differentiating Delirium and Dementia
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So tt’s serious!
Delirium is not something to be taken lightly and requires medical intervention and close monitoring It can last weeks to month even after discharge from hospital
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What can you do as a Caregiver?
Look after yourself first …
§ get plenty of rest § make sure you are eating § accept support and offers of help
Help to make the environment safe and relaxing for the person with delirium Provide activities or objects of comfort to the individual Seek medical advice and ongoing support/ monitoring
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The Doctor will want to …
Treat the potential causes of the delirium Provide education Make suggestions to you and others about the environment Review all medications
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The Doctor might suggest to …
Minimise medication use and/or avoid some medications Use sedation (only if severely agitated and restless, and real concern of risk) Avoid PRN use of medication, if possible Use of medication to help minimize the symptoms
- f the delirium
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