Delirium

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Delirium – Information for patients, families and Friends

 

It is our hope that this article will help you learn more about:

What is Delirium?

  • The signs and symptoms
  • How it can be prevented and
  • What families, friends and caregivers can do to help
  • Where to find more information

What is Delirium?

Weaving Secret Riddle Confusion Thread Patterns

Delirium is a condition that causes a person to be confused. It is a physical problem (a change in the body) that can cause temporary change in the person’s thinking. Delirium usually starts over a few days and often get better with treatment.

Delirium can happen to anyone, anywhere. But, it often happens when someone is in the Hospital

 

Once identified, delirium is often treated as a medical emergency. Treatment is put in place right away because it can be a risk to patient safety.

 

Delirium can cause patients to slip and fall or to feel a lot of emotional and spiritual distress. A person with delirium may not be able to understand when people are trying to help them. They may become angry with family and hospital staff. They may start to think that everyone is against them or are trying to harm them. Some people with delirium may want to call the police to get help.

Delirium is like being in the middle of a very strange dream or nightmare, but the person is having these experiences while they are fully awake.

 

What is the risk of delirium?

  • About 20 out of 100 patients admitted to hospital will experience.
  • About 70 patients out of 100 admitted to the intensive care unit will experience delirium. 

 

What causes delirium?

Delirium can be caused by:

A Physical illness (that brought someone to the hospital)
  • Someone who is ill can have changes in their body chemicals, become dehydrated (not enough water in the body) or get an infection, such as a bladder infect or urinary tract infection. These kinds of problems can cause delirium.

 

Medications

  • The medications the hospitals use to treat illness or control pain can cause delirium

 

Is delirium the same as depression or dementia?

No. Delirium can happen more often in people who have dementia or depression, but it is different.

Delirium happens quickly. It can come and go at any time. This does happen with dementia and depression.

Patients with delirium cannot focus their attention. This is different from patients with dementia and depression.

 

Types of Delirium

There are 2 types of delirium:

  1. Hypoactive delirium

This type of delirium happens most often in elderly patients but can affect anyone at any age.

Patients with hypoactive delirium may:

  • Move very slowly or not active
  • Not want to spend time with others
  • Pause frequently when speaking or not speak at all
  • Look sleepy
  1. Hyperactive delirium

This type of delirium is easier to recognize.

Patients with hyperactive delirium may:

  • May be worried and afraid
  • Be restless (not able to stay still or have trouble sleeping)
  • Repeat the same movement many times
  • Experience hallucinations (seeing something or someone that is not really there).
  • Experience delusions (believe something that is not true).

At times a patient can have both hypoactive and hyperactive symptoms.

 

What are the signs and symptoms of delirium?

A check list:

Disorganized thinking                                                      YES                NO

Saying things that are mixed up or do not make sense

Difficulty concentrating                                                   YES                NO

Easily distracted or having difficulty following what is being said

Memory changes                                                                YES                NO

Not able to remember names, places, dates, times or other important information

Hallucinations                                                                     YES                NO

Seeing or hearing things which are not real

Having delusions                                                                YES                NO

Thinking or believing things which are not true or real

Feeling restless .                                                                 YES                NO

Not able to stay still, trouble sleeping, getting out of bed

Changing energy levels                                                     YES                NO

Changes from being restless to being drowsy or sleepier than usual

 

How can delirium be prevented?

All patients should be carefully screened (checked) for these factors that may cause delirium:

  • Hearing problems
  • Vision problems
  • Not enough water in the body (dehydration)
  • Not being able to sleep or other sleep problems
  • Dementia, depression or both
  • Difficulty getting up and walking around
  • Medication being taken
  • History of alcohol or recreational drug use
  • Chemical changes or imbalances in your body
  • Low oxygen in your body
  • Other health condition or illness

Having trouble:

  • Thinking clearly, reasoning, remembering and judging
  • Concentrating
  • Understanding
  • Express ideas

 

How is delirium be treated?

  1. The health care team helps the patient stay safe and calm
  1. They will try to find the cause of the delirium. Often, there is more than one cause. They also make sure any factors they find are not caused by another medical condition
  1. Then they will address the factors or ease the symptoms.

This could include:

  • Reviewing and changing medications
  • Provide fluids to rehydrate
  • Correcting chemical problems in the body
  • Treat infections
  • Treating low oxygen levels

 

What can family and friends do to help?

Family and friends and caregivers can all help to prevent delirium for their loved ones in hospital.

 

Keep a careful watch for the signs and symptoms of delirium

  • If you see any signs that could mean delirium talk with your health care team right away. Family members are often the first to notice these small changes.
  • Use the signs and symptoms check list and factors list listed on this article to guide your findings.

 

Help with healthy eating and drinking while at the hospital

  • Ask what is right for your loved one before they eat and drink.
  • Make sure they have their dentures (if needed).
  • Encourage help with eating. Feel free to bring their favourite foods from home, check with the health care team about foods they should not eat.
  • Encourage them to drink often, if that is right for them.

 

Keep track of medications

  • Share a complete list of their prescriptions and any over the counter medications they take with the health care team… including the dosage.

 

Help with activity

  • Ask what is right for your loved one before starting any activities.
  • Talk to the team about helpful and safe activities.
  • Help them sit, stand and walk.

 

Help with mental stimulation

  • Make a schedule for family and friends to visit. This will help your loved one feel safe and comforted.
  • Speak to them in a calm, reassuring voice.
  • Tell them where they are and why they are there throughout the day. If possible, place a large sign in their room or write information on it.
  • For example, you could write: Today’s date, weather, where they are and their room number… this will help them stay connected.
  • Give them instructions one at a time. Do not give too much information at once.
  • Bring a few familiar objects from home, such as photo albums and their favourite music. If your loved one needs special care to prevent the spread of infection, check with the care team first.
  • Open the curtains during the day time.
  • Talk about current events.
  • Read the newspaper out loud or use talking books

 

Help them with eyesight and hearing

  • Make sure they wear their hearing aids or glasses, if they need them.
  • Make sure there is enough light in the room.
  • Help them use a magnifying glass, if they need one.

 

Help them rest and sleep

  • Reduce noise and distraction.
  • Soothe them with handholding, a massage, a warm drink or music.
  • Bring a night light, but check with the health care team first.
  • Use comfort items like their favourite pillow and blanket.
  • Limit the number of visitors who come to see your loved one until the delirium goes away.
  • The health care team may not give your loved one sleeping medications because it could make delirium worse.

 

Take care of yourself

It is not easy to be with a person with delirium, even though you may understand the problem

  • Make sure to look after yourself and get some rest. Go out for short walks, remember to eat and drink fluids to keep up your energy levels.
  • It may help to share your thoughts and feelings with someone. Feel free to speak with the health care team.
  • Try not to become upset about the things your loved one may say during their delirium state. People with delirium are not themselves. In many cases, they will not remember what they said or did.

Who can I talk to if I have more questions or concerns?

There are many members of the health care team who can offer help and support. Talk with your doctor or nurse and any member of the health care team, including a Psychiatry, Spiritual Care or Social Work departments. They will answer any questions or concerns you may have about delirium.

 

Delirium should go away or be greatly reduced with the right kinds of treatment… although in some cases some of the symptoms may remain for an extended period of time.

More information can be found on these helpful websites:

Delirium Mayo Clinic                     www.mayoclinic.com/health/delirium/DS01064

Delirium MedlinePlus                   www.nlm.nih/gov/medlineplus/delirium.html

 

Videos:

Youtube – How to recognize Delirium             www.youtube.com/watch?v=hwz9M2jZi_o

Many other videos choices will be available when you log on to this site.

 

Grief, Bereavement and Loss

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grief2Grief, Bereavement and Loss

A guide to coping with loss after the death of a loved one

Coping with the death of a loved one is a personal experience. There is no normal or perfect way to respond. 

It is our hope that this article will:

  • Help you understand your feelings of grief
  • Offer ways to cope with your grief
  • Give you information and resources you need

What does grief, mourning and bereavement mean?

  • Anticipatory grief is the feeling of grief that can happen before your loved one’s death.
  • Grief is the personal response to a loss
  • Mourning is a process of adapting to the death of your loved one
  • Bereavement is the time spent grieving after your loved one’s death

 

The person loved is no longer alive, but the memories will live on forever. That part of your whole being that loves him/her is embraced when you allow yourself the privilege of remembering.          Alan D. Wolfelt

 

What can grief feel like?

When someone you love dies, your emotions, health, social life and spiritual wellbeing can change. You may feel unusual and upset by these changes.

You may experience:

  • Feeling numb
  • In disbelief that your loved has died
  • Anxiety and distress
  • Loneliness
  • Anger
  • Guilt
  • Sadness
  • Depression
  • Confusion
  • Trouble focusing and making decisions
  • Crying or Sighing
  • Having lucid dreams about your loved one
  • Seeing images of your loved one
  • Feeling relieved
  • Aches and pains
  • Upset stomach
  • Loss of sleep and being tired
  • Changes in sleep and appetite

You may lose interest in:

  • Day-to-day routines
  • Sex or intimacy
  • Relationships

How long will I grieve?

Grieving is a process.       Everyone experiences grief differently. There is no right or wrong way for you to react to the death of a loved one.

Symptoms of grief will occur less often and fell less intense as time passes. As symptoms of grief lessen, you will feel able to return to day-to-day life.

People can have both good and bad days when they’re grieving. Grief can come in waves of strong emotional feelings caused by reminders of your loved one… sometimes for no apparent reason at all.

Feelings of grief can return or feel worse on special days like birthdays, anniversaries and holidays when your loved is especially missed. It is normal to revisit your grief throughout your life… even when you have moved on.

 

Mourning never really ends. Only as time goes on it erupts less frequently – Alan D. Wolfelt

 

How can I help myself?

Body
  • Take care of yourself
  • Talk to your family doctor about any physical concerns
  • Take part in activities you enjoy such as going for a walk, reading or exercising
Social
  • Talk with a friend, family member or a member of your faith community
  • Share memories, stories and photographs of your loved one
  • Join a group or do one-on-one counselling – This can be done in person, by phone or over the internet.
Emotional and Spiritual
  • Be patient – grieving takes time
  • Know that other people have responded in the same way
  • Let yourself experience the pain of grief
  • Know that it is alright to express your feeling
  • Write a letter to your loved one… express yourself and keep it safe
  • Use the resources of your faith and spirituality

 

There is help… Reach out!

Bereaved Families of Ontario:       416-595-9618 .     http://www.bereavedfamilies.net
  • Provides group, one-on-one and phone support for adults, teenagers and children

 

Canadian Virtual Hospice:          http://www.virtualhospice.ca
  • Information and support on palliative and end-of-life care, loss and grief.

 

Respite Services:               http://www.hospice.on.ca/hospiceontario.php
  • Has over 180 associate and individual members who provide free bereavement support across Ontario.

 

University Health Network Bereavement Support Group – 416-603-5836
  • Offers an 8 week bereavement group

 

Wellspring Cancer Support Network:     416-961-1228           http://www.wellspring.ca
  • Community-based cancer support centres that offer a variety of programs to individuals and family members

 

Other Resources:

  • Your faith or spiritual community
  • Your family doctor or health team
  • Your Funeral Home

Grief only becomes a tolerable and creative experience when love enables it to be shared with someone who really understands – Simon Stephens

 

 

Caregiver Stress

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Stress3

Managing Caregiver Stress

For people caring for a loved one, stress can be overwhelming to the point of debilitation.

Read this information to learn:

  • * Who a caregiver is
  • * What caregiver stress is
  • * How to know if you have caregiver stress
  • * How you can help manage caregiver stress
  • * Who to call if you need help

Who is a Caregiver?

A caregiver is anyone who gives care and help to someone else. A caregiver may support a spouse, parent, sibling. Child or another family member or friend. A caregiver may be giving support to someone else because of health conditions, age, disability or injury.

Caregiving can include many different types of activities, such as:

  • Cooking, cleaning, shopping and helping someone with their household chores/needs
  • Helping someone with their day-to-day needs, such as dressing and bathing
  • Driving or going with someone to health care appointments
  • Helping someone who needs you in many other ways

You may not see yourself as a caregiver… but if you are giving care and assistance to someone else, it is important to recognize the caregiving work you do.

I’m caring for a loved one. Is it normal for me to feel stressed?   Yes it is normal

This stress is called caregiver stress. Sometimes caregivers can feel more stress than the person being cared for. You may be so busy caring for your loved one that you forget to care for yourself. This can be tiring and stressful.

You may not want to take time away from your loved to deal with your own challenges… leading to more stress. Overwhelming levels of stress can affect your loved one too. They start to see and feel your stress as well. To help your loved one, you need to take care of yourself.

How can I tell if I have caregiver stress?

Sometimes, it’s hard to tell how stressed you feel.

Ask yourself if you are feeling these ways:

  • I can’t get enough rest
  • I don’t have time for myself
  • I don’t have time to deal with other family members
  • I feel guilty about my situation
  • I don’t do other things anymore, beyond taking care of my loved one
  • I have arguments with the person I care for
  • I have arguments with other family members
  • I cry often about the situation I’m in
  • I worry about finances
  • I don’t know the best way to care for my loved one
  • I feel my health is declining

If you usually or always feel these ways, you may have caregiver stress.

What are the different kinds of caregiver stress?

You might have one or more of these kinds of stress:

Physical:
Taking care of a loved one can be tiring. You may not have time to eat well and exercise. This can affect your own health. Helping your loved one move around or move from bed to chair can also be hard on your own body.

Financial:
It can be expensive to provide care to your loved one. Trying to manage all these costs can cause stress.

Environmental:
You may have gone through many changes to help care for your loved one. How you spend your day or where you live may have changed. These kinds of changes can cause stress.

Social:
You may be spending so much time with your loved that you don’t have for other family members and friends. Not having family and friends around for support can be stressful.

Emotional:
Different kinds of caregiver stress can cause to feel:

  • Helpless
  • Depressed
  • Lonely
  • Self-doubt
  • Embarrassed
  • Frustrated
  • Afraid

Sometimes, you may also start to feel angry or resentful towards the person you’re caring for. These feelings are completely normal, and they can cause you to feel guilt and stress. Knowing the kinds of stress you feel can help you make the right kinds of changes.

What can I do to reduce caregiver stress?
Here is a list of things you can do to help reduce the stress you may be feeling:

Take care of your physical needs

  • Make sure you east at least 3 healthy meals a day.
  • Try to exercise for at least 2 or more hours each week. Even a brisk walk can make a difference on how you feel.
  • Try to get at least 7 or 8 hours of sleep each night.
  • Make sure you keep your medical and dental appointments.
  • Talk to your family doctor or another care provider for help if you are having physical symptoms of stress.

Look into financial and work place support

  • Speak to your employer to let them know you may need to go to more appointments than usual. It may help let them know what is happening in your life. Also find out if your employer has any family caregiver benefits or flexibility, such as a caregiver time-off program.
  • Financial help may be available. Talk to your social worker about programs through the government or other agencies that can help you manage all the costs. (See bottom of article for some links)

Daily living

  • Try to get help with some of your daily chores/routines.
  • Be realistic about what you can and cannot do. Don’t try to everything – no one can do it all.
  • Ask for help when you need it and accept help if others offer. Even small things, like someone offering to shovel the walk or pick up groceries, can make a big difference in your day.

Stay connected with others

  • Talk with others who have had similar experiences, like a friend or a neighbour. Knowing you are not alone can help you feel better. You can also try a support group. This is a group of people in a similar situation who meet regularly to share their experiences. There are also online discussion groups or other ways to connect with people if you can’t easily go somewhere outside your home.
  • Talk to you friends and family regularly, and share your feelings with them.
  • If you’re a member of s cultural or religious community, find out if any programs or support is available through these groups.

Accept your emotions

  • Don’t be too hard on yourself. Accept how you’re feeling
  • If you can’t find the time to do things that you need or want to do while your one needs care or company, consider respite care. Respite care, which is short term relief for caregivers, is available to give caregivers some time away to rest or attend to other issues. For more information on respite care (see below).

Where can I get more help if I need it? 

Below are some general, Toronto based links… they can redirect your enquiry to your own region.

Family Services Toronto:            416-595-9618   

www.familyservicetoronto.org
Family services offer workshops on senior and caregiver support services, and also has counselling services, a caregiver support group and mindfulness seminars to help caregivers adjust to their new role.

Caregiver Connect:          

http://www.von.ca/caregiver-guide/default.aspx
A valuable source for caregiver information and support services. Visit the website and click on “Locations” to find contact numbers, programs and services available in your area

Respite Services:              

www.thehealthline.ca
Respite care gives short term, temporary relief to caregivers. It can range from a few hours to a few weeks. There may be a charge for respite care. To find respite programs and contact numbers in your area, enter your postal code on the website shared. Select people with disabilities.

Community Care Access Centre (CCAC)          

www.healthcareathome.ca     310-2222 (no area code required)
CCAC connects people and caregivers with health services and resources to support them at home and in their community. CCAC may also offer respite care. To find the nearest branch, use this website and enter your postal code and click on the map.

 Telehealth Ontario:         

1-866-797-0000        (TTY 1-866-797-0007)
Telehealth Ontario is staffed by registered nurses who can provide non-emergency advice or information. This service is open 24 hours a day. It’s confidential and is available in many languages. You do not need a health card to call.

Social Assistance in Canada http://www.servicecanada.gc.ca/rng/lifeevents/caregiver.shtml
This link will help you find information on various forms of assistance such as the compassionate care benefit or the caregiver tax credit.

Canada Revenue Agency, Tax Credits and Deductions for Persons with Disabilities www.cra-arc.gc.ca/familycaregiver/
Use this website to see if you qualify for the Family Caregiver Tax Credit