Delirium in Older People

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the individual’s environment.

It can be difficult to distinguish between delirium and dementia as both conditions exhibit similar signs and symptoms. Adding to the complexity of making a diagnosis, delirium frequently occurs in people living with dementia. The individual may well have both conditions.

Care staff can distinguish between delirium and dementia by taking note of the onset and fluctuation of symptoms. The onset of delirium occurs quite rapidly, typically within a matter of days or even hours, whilst dementia is a condition that initially presents with minor symptoms that gradually worsen over time.

Symptoms of delirium are also known to fluctuate significantly and frequently throughout the day, whereas whilst those with dementia do have better times of day, memory and thinking skills will stay fairly constant throughout the course of the day.

Delirium is most often caused by:

  • Medication
  • Surgery
  • Infection
  • Severe or chronic medical illness
  • Changes in metabolic balance

Common signs and symptoms of delirium include:

Emotional disturbance

  • The individual appears irritable or angry.
  • May display in rapid mood changes.

Behavioural disturbance

  • The individual is restless, agitated or combative.
  • May be displayed in continued pacing or inactivity (individual appears sluggish and drowsy).

Reduced awareness of the environment 

  • Inability to remain focused on a topic, or an inability to switch topics.

Cognitive impairment

  • Poor thinking skills.
  • Individual is unsure of who or where they are.
  • May display in hallucinations or the appearance of being in a daze.

Risks of Delirium in Older People

As stated above, delirium is of high risk for older people upon being admitted to hospital, if the individual does not already have delirium upon admission.

There is a significantly higher chance of those over 70 developing delirium in a hospital setting. This is problematic as delirium severely impacts an older person’s ability to recover from intensive care situations such as surgeries.

Cognitive decline combined with increased likelihood of pressure sores, incontinence and falls all contribute towards a far more complex and lengthy recovery period for the older patient.
Therefore, it is crucial for health providers in residential and in hospital settings to do all they can to prevent or if not possible, manage delirium to prevent the individual’s condition further declining.

Treating & Management of Delirium

Once it has been determined an individual in residential care does have delirium, it is essential the care staff identify any risk factors and ways to best mitigate these.

Screening

  • Comprehensive history of the resident’s health (sensory impairments, falls, medication, cognitive and functional status)
  • Baseline cognitive function assessment – to be repeated whenever the resident returns from hospital or has been acutely unwell

Diagnosis

  • Confusion Assessment Method (CAM) a diagnostic tool for the initial diagnosis of delirium, performed by assessing the resident’s current status

Management & Treatment

Delirium can be managed with ongoing monitoring of the resident’s heath status, using assessments including:

  • Pain Assessment in Advanced Dementia
  • Abbey Pain Scale
  • Physical Behaviour Assessment
  • Care plan interventions and updates as and when changes in condition occur
  • Minimised use of anti psychotic medications

The facility should also be implementing clinical and environmental strategies to mitigate risk and respond to any changes in the resident’s condition.

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This post was written by Admin