Infuse Issue 14 October 2021 - Page 31

Delirium is a serious condition . It can be considered an “ acute brain failure ”. It is categorised by inattention and an acute change in cognition due to a medical condition , medication and / or intoxicating substance 2 . Delirium is very different to dementia in that it often has a rapid onset ( hours to days , rather than months to years ) and has a fluctuating course . A person with delirium can seem “ normal ” one day , and confused , drowsy , agitated or even aggressive the next . It can have a short duration or last for a long time , even after hospital discharge .
Delirium is a highly distressing experience for the person , their family and the staff caring for them 3 . People often talk about their delirium as living their worst nightmares , speaking of scenarios such as being kidnapped , locked away in prison , drowning or in a plane about to crash . This can lead them to view hospital staff , food , drinks and medications with suspicion and fear , and cause aggressive refusal or attempted escape . Subsequently , the use of restraint or sedation may be necessary , which carries further risk of harm to the patient . These experiences feel very real in the moment , and the memories can remain with the person and their family for a long time .
Delirium , however , doesn ’ t always present in this way . Some patients experience hypoactive delirium , which can present as apathy , drowsiness , disorientation and motor slowing – but it can be just as dangerous as it more often goes undetected and unmanaged . It also leads to poor oral food and fluid intake , poor engagement in self-care and mobility and a cascade of harmful complications such as falls , pressure injuries and incontinence , which can translate to long hospital stays and residential care placement .
Anyone who is unwell can develop delirium , even children . A fit and healthy person can develop delirium after major trauma , illness or surgery , though it is most common in older and / or more frail people and can occur with relatively minor issues like urinary tract infections , dehydration or hyponatraemia . There are usually several contributing factors , and things done to the patient in hospital that can add to the risk ; for example , intravenous lines , nasogastric tubes and catheters . Interrupted sleep and environments where it is hard to identify the time of day ( no clocks or windows ) can also contribute .

Delirium can be considered an “ acute brain failure ”. It is highly distressing for the person , their family and the staff caring for them .

© Dietitian Connection 31 Infuse | October 2021