What is delirium?
Delirium is also known as acute confusion or acute brain failure. Regularly delirium related confusion develops in a short period of time (usually within a few hours or days), can fluctuate in severity throughout the day, and always has a physical cause (Source: APA, 2013, Diagnostic and Statistical Manual of Mental disorders (Fifth Edition), DSM-5).
What causes delirium?
Delirium is caused by illness, injuries (e.g. hip fracture following a fall), surgery, or a wrong combination of medicines.
Who will develop delirium?
Anyone can get delirium. Older age and dementia greatly increase the chance of becoming delirious.
What is the difference between a hyper and a hypoactive delirium?
Delirium patients can be hypoactive (apathetic / silent), mixed, or hyperactive (restless and agitated). Hypoactive delirium is regularly confused with depression and dementia. The recognition of a delirium is often complicated by these different types. Up to 75% of the patients with delirium have hypoactive delirium (Source: Marcantonio, 2017, NEJM).
How common is delirium?
Approximately 33% of admitted patients over 70 years of age develop delirium, as stated by Marcantonio in 2017. Delirium is the most common complication after surgery in elderly patients over 70 years of age in which:
- 15 to 25% of older patients develop delirium following major surgery
- 50% of older patients develop delirium after high-risk surgery such as trauma surgery
- Inouye states that on the ICU 19%-82% of patients develop delirium, depending on the population (2014, The Lancet)
What is the big deal about delirium?
Even after a short (hypoactive or silent) delirium episode, the chance of poor recovery from illness, functional decline and hence, possible admission to a nursing home is high. There is an increased risk of dementia and / or death.
Delirium is stressful for the patient and can cause frightening thoughts or hallucinations, such as feeling imprisoned or seeing images that are not real. It can also cause anxiety and agitation for family members and caregivers.
How is delirium is being treated?
As soon as possible it is important to address the underlying condition(s) or remediate any medication that may have triggered the delirium. These form the main treatments of delirium as, unfortunately, there is no drug available for the treatment of delirium. Other measures that may be taken include:
- Wearing of glasses and / or hearing aids (or is this meant to be earplugs?)
- Reassurance, re-orientation and avoidance of conflicts;
- Helping the patient mobilise and get out of bed;
- Creating an environment to allow the patient to sleep peacefully at night;
- Talking quietly and encouraging the patient to play games or solve puzzles;
Are doctors and nurses familiar with delirium?
Delirium is a serious problem, affecting all hospitals. However, many delirium cases are under recognised. Only 12% to 35% of delirious patients are recognized. Up to 75% of delirium patients are suffering from hypoactive / silent delirium. Hypoactive patients, in particular, are being missed when using the current screening methods. (Source: Marcantonio, 2017, NEJM)
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