Delirium

Question 1

What are the key features of delirium?

Answer 1

Disturbed consciousness; hypoactive/hyperactive/mixed

Change in cognition; memory/perceptual/language/illusions/hallucinations

Acute onset and fluctuant

Question 2

What are some common features of delirium?

Answer 2

Disturbance of sleep cycle

Disturbed psychomotor behaviour (affects your physical function)

Emotional disturbance

Question 3

Who is at risk of delirium?

Answer 3

Extremes of age; old and young

Those with cognitive and/or physical frailty

Having a sense of cognitive frailty will help identify precipitations - “delirium threshold”

Question 4

What precipitates delirium?

Answer 4

Infection
Dehydration
Biochemical disturbance
Pain
Constipation/Urinary retention
Hypoxia
Alcohol/drug withdrawal
Sleep disturbance
Brain injury; stroke, tumour, bleed etc
Changes in environment/emotional distress

Question 5

How common is delirium?

Answer 5

Common complication of hospitalisation

20-30% of inpatients

Up to 50% of people post-surgery

UP to 85% of people at end of their life

Question 6

Describe non-pharmacological treatment for delirium

Answer 6

Re-orientate and reassure; use families/carers

Encourage early mobility and self-care

Correct sensory impairment

Normalise sleep-wake cycle

Ensure continuity fo care; avoid hospitalisation, avoid frequent ward/room transfers

Avoid urinary catheterisation/venflons

Discharge people ASAp

Question 7

Describe pharmacological management of delirium

Answer 7

Stop precipitating drugs

Drug treatment for delirium usually not necessary

Only if danger to themselves/others or distress that cannot be settled otherwise

• start low and go slow
• 12.5mg quetiapine orally
• this should be a consultant/registrar decision

Question 8

What is the delirium screening tool used in NHS Grampian?

Answer 8

4AT

• Alertness
• LADY questions
• Months of year backwards
• Acute change

Question 9

Describe the TIME bundle

Answer 9

A checklist for delirium

• think, exclude and treat possible triggers
• Investigate and intervene to correct underlying causes
• management plan
• Engage and explore

Question 10

What is the association between delirium and falls?

Answer 10

4.5x more likely to fall if have delirium

Delirium prevention interventions reduce falls also

Question 11

How to prevent delirium?

Answer 11

Preventable in 30% of cases

• orientation; ensure patients have glasses and hearing aids
• promote sleep hygiene
• early mobilisation
• pain control
• prevention, early identification and treatment of post-op complications
• maintain optimal hydration and nutrition
• regulation bladder and bowel function
• supplementary oxygen, if appropriate
• medication review