Dealing with delirium

DELIRIUM is very common and can be very scary for patients and their relatives. Early recognition of the signs and prevention are the key to a better outcome. Family members can play a huge part in picking up signs and managing their loved ones’ condition.

Here are some of the common questions about the condition and some useful answers.

What is delirium?
Delirium is defined as a temporary state of confusion which could be constant or fluctuating. The main brain function that is affected is attention leading to difficulty in focusing and disorganisation in thinking. There may also be changes in memory, conversation skills or ability to recognise people.
 
What are the types and symptoms of delirium?
There are two main types of delirium. The first is hyperactive, which is characterised by symptoms of physical aggression, hallucinations (seeing or hearing things that are not there), delusions (believing something to be true in spite of good evidence to the contrary) and night time sleep disturbances.

The second is hypoactive, which is characterised by excessive sleepiness and behavioural withdrawal.

What conditions increase the risk of developing delirium?
The conditions that may increase the risks of delirium include: old age, problems with hearing and seeing, mood problems, multiple long term and acute illnesses, dehydration, chest or bladder infections, stroke, imbalance of salts in the blood, physical and mental disabilities, kidney failure, Parkinson’s disease, dementia and the use of sedatives and painkillers.

How is delirium recognised?
When elderly persons are delirious they often cannot express their concerns or look for help. They would present with the symptoms mentioned above. Once recognised, the root causes must be found and corrected. By alerting the nurses or doctors and by identifying some of the possible causes, family members and friends can help solve the puzzle.

You should always seek medical attention if you notice any of the aforementioned symptoms.

How is delirium prevented?
Relatives and caregivers have an extremely important role in preventing and treating delirium.

The most important method one is preventing illness. This includes leading a healthy lifestyle, daily exercise, eating healthy foods and avoiding smoking. Living healthy will boost the immunity and prevent illness from occurring therefore, lessen the risk of delirium.

Alcohol, in any amount, should be avoided. Medications must be regularly checked by your doctor on a monthly basis to make sure there are no conflicts. You should always avoid culprit medications such as: painkillers (opiates and benzodiazepines), antihistamines, anticholinergics, and bladder or muscle relaxants. Early physical activity and drinking plenty of fluids after surgery is also important.
 
Patients who have visual or hearing problems should have those corrected to avoid sensory deprivation.

How is delirium treated?
The most important part of treatment is identifying the cause and curing the root problem.

When delirious, patients become vulnerable, scared and at great risk of injury – therefore supporting them to get through the delirium phase and back to normal is essential.

Families play a major role in supporting their loved ones and can work with the hospital staff to re-create a comforting, familiar setting in the hospital by placing familiar objects around the room and visiting  as much as possible.

Approaching such patients should be in a calm and pleasant way. You should also avoid negative remarks or emotions for example, instead of saying ‘do not get of the bed because you might fall’ – we should say ‘stay on the bed because it’s safer’.

Physical pain and psychological stress should also be reduced. Communication aids if needed, getting enough food, liquids, physical activity and sleep are important.

If those methods fail and the patients are at risk of harming themselves or others, then certain medications can help calm them down like haloperidol or quetiapine.

For more information, please visit https://www.americandeliriumsociety.org/ and https://www.alz.org/

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