clinical focus
Delirium dilemma
Delirium is widespread in the ageing community. It is often missed by professional carers, and more training and diagnostic skills are required.
Annmarie Hosie interviewed by Dallas Bastian
Delirium affects a quarter of older people in hospital and has the same death rate as heart attacks, yet it is often missed or untreated by health professionals in wards, residential aged care facilities and the community.
This concern was raised by academics from the University of Technology Sydney and the Prince of Wales Hospital, in east Sydney, on the most recent World Delirium Day, March 15.
Dr Annmarie Hosie, a post-doctoral research fellow at UTS, said delirium occurs when illnesses, injury, surgery or medicines cause a sudden and severe decline in a person’ s mental function.
“ The result is reduced ability to concentrate, think and communicate, and sleepiness and / or agitation,” Hosie and her colleagues said in a public statement.
“ Many people also have disturbing hallucinations or paranoid delusions. Delirium usually lasts for hours to days, but for some people it may last for weeks, even months.”
Hosier sits down with Aged Care Insite to discuss the reasons delirium is often missed and the signs health professionals should look out for.
ACI: Why is the condition often missed by health professionals and left untreated. AH: The first reason that we don’ t recognise it well is that it presents quite differently in different people, at different times and even different parts of the day. There’ s diagnostic criteria for delirium which helps us to understand how all the different ways it manifests can be framed together and understood as one syndrome. But those diagnostic criteria are not well-known to
clinical staff, particularly nurses, because those criteria sit within the diagnostic and statistical manual of the American Psychiatric Association.
Delirium is an interesting condition because it creates changes to people’ s thinking, and attention, and awareness. Those changes happen because there’ s a physiological imbalance in the body.
People who are very unwell, very injured, or very frail due to older age, are more at risk of getting delirium, or will often have delirium as a result of that physiological imbalance. But it manifests as a psychiatric condition.
It’ s quite a complex syndrome of a whole range of different things that can happen for someone. Some patients will be very quiet and some will be very agitated. Some patients will have hallucinations and some will not. So trying to make sense of all that for different people is quite complex if you don’ t know that diagnostic criteria.
The second reason is to do with the complexity of the condition. It’ s to do with that framework for what it is not being readily available to people who provide the care at the bedside.
The third reason is that we don’ t have systematic processes [ or routine screening for delirium ] in place in hospitals or in residential aged care centres. With pain in the palliative care population, you’ ll routinely screen the person for pain. But that doesn’ t happen with delirium generally, although in some settings, it’ s becoming more common that there are routine processes to look out for delirium.
Another reason [ it may not be recognised ] is that we don’ t get taught a lot about delirium in undergraduate education. I think, often, health professionals will tend to start learning about delirium about mid-career where you start to recognise … this thing that you’ re seeing in patients. But that is often years after you’ ve been looking after people and really not being able to make head nor tail of what’ s going on when they become delirious.
So I would say to any nurse or anyone caring for patients, particularly in higher-risk areas, that they know what the diagnostic criteria are. Even if you’ re not a doctor, it’ s still really important that the whole team knows what that is, because you need everyone to be on the same page.
18 agedcareinsite. com. au