what is delirium?
an acute change in mental state
What are the signs of hyperactive delirium?
Agitated aggressive incoherent speech disorganised thoughts delusion hallucinations disorientation
what are the signs of hypoactive delirium?
sluggish
drowsy
withdrawn
less reactive
which type of delirium might a patient get?
A patient can swing between having hyperactive AND hypoactive delirium.
what symptom is common in both types of delirium?
Sleepiness.
disturbed psychomotor behaviour
emotional disturbance
what is the difference between dementia and delirium?
Dementia: - comes on over months/years. - don't have hallucinations delirium: - sudden onset. - can have hallucinations
what are the risk factors of delirium?
- surgery
- lack of sleep
- pneumonia
- UTI
- previous delirium
- consipation
- opiates
- extremes of age (old most common, can still get in young).
- frailty
- dehydration
- pain
- hypoxia
- alcohol/drug withdrawal
- changes in environment
- emotional distress
- stroke/tumour/bleed
how much more likely is someone with delirium at risk of a fall?
up to 6X more likely to fall.
how much more likely is someone with delirium at risk of a fall?
up to 6X more likely to fall.
when is delirium worst?
Often worse at night.
how common is delirium?
Commonest hospital complication
how much percentage of people get
what percentage of people develop delirium in hospital?
- 20-30% of all in patients
- up to 50% of post surgery people
- up to 85% at end of life
what percentage of people develop delirium in hospital?
- 20-30% of all in patients
- up to 50% of post surgery people
- up to 85% at end of life
Which test is done to assess delirium?
4AT test
who should be tested for delirium?
Anyone who is admitted to hospital >65yrs.
which questions are asked in the 4AT test?
LADY Location Age Date of birth Year
what is the treatment for delirium?
Mainly non-pharmacological:
- re orientate
- encourage mobility and self care
- give hearing aids and glasses if they have
- normalise sleeping pattern
- try to treat at home as much as possible
- discharge from hospital ASAP
- avoid medical procedures - eg catheterisation
what is the pharmacological management of delirium?
stop bad drugs
drugs for delirium are not usually necessary
Which medication can be given as a last resort?
Quetiapine
how much delirium is preventable?
30%
what are people more likely to develop after having delirium?
another episode of delirium
dementia
other frailty syndromes
what should not be done for UTI in older people?
should NOT be diagnosed using urine dipstick - often come up positive.
