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.

 

Things you need to know about talking to your ageing parents

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Having the Talk? Here’s a few tips.

If you have not had “the talk” with your ageing parent/s, don’t put it off any longer. While mom and dad are cognitively intact the process is pretty straight forward… albeit, it can be somewhat uncomfortable for both parties. It needs to be approached from the same angle as if the conversation was to be had with you by your own grown children.

IOC The talk1Talking about the future can be hard. Such discussion will invoke anxiety in even the most calm of us when we start to think about all the unknowns in our futures and those of our loved ones. These discussions can get even harder when it’s not our future we’re talking about, but rather someone else’s. However, as difficult as it may be, there are some questions that we need to have answers to when it comes to our ageing parents and it is wise to have these conversations sooner rather than later. On that note, here are 7 basic questions that you should include in the “talk” with your ageing parent/s… as soon as you can.

1. How do they feel about getting older or having to get help to sustain their independence?

A parent/s can have all the legal stuff taken care of, but that doesn’t tell you how they feel. To really understand your ageing parents, it’s important to talk about how they feel about the situations that might happen.  Allow them to talk about their fears, their wishes, how they envision things unfolding in the event of a medical situation, and so on.  This is the type of conversation that will tell you if they have made decisions based on what they think will be easiest for others or what they really want.  This is the type of conversation that will allow you to make sure that the legal documents accurately represent your loved one’s wishes.  Most importantly, it is the type of conversation that will allow your ageing parent/s to know how much you support and love them and want what is best for them.

2. Do they have a will? Is the Will is safe keeping and up-to-date?

Bringing up a will can seem like you only care about what you’re getting, but a will contains so much more than just ‘who gets what’ and is essential to the process of handling matters when a loved one passes. This is your parent’s opportunity to dictate how they would like their affairs to be handled and who they want to handle things.  It is equally important for our parent/s to ensure their will is up-to-date so that loved ones don’t end up in bureaucratic chaos trying to simply execute the wishes of a loved one while simultaneously trying to mourn. Importantly, the same questions pertain to life insurance, which is separate from a will and requires the beneficiaries to be named to the life insurance company directly.

3. Do they have a living will?

Although many people plan for their deaths, many forget to also plan for any situation that might render them incapable of making their own decisions while still living.  Your parent/s may assume that the “right” decision will be made for them, by those in charge. This is not always how it plays out. Taking the time to decide what they want and making sure those wishes are legally noted is the only way to ensure your parents will be cared for in that way.

4. Do they have a Power of Attorney?

This can be one of the trickier topics to discuss if there are multiple children or individuals who might expect to be “chosen”.  Parents sometimes put this off because they simply don’t want to be seen as picking favourites, but it’s an essential document to have.  For this reason it is important that children (and any other interested individual) are respectful of whatever decision the elder makes.  No offense should be noted to the parent/s and if there are concerns about a selection, it would be wise to make sure all parties are involved in discussing this instead of trying to quietly bring it up to the parent. By involving everyone, the right decision for your aging parent can be made.

5. Do you have long-term care insurance?

Not all people have invested in long-term care insurance and with the costs of long-term care. This is something your parents may want to consider if it’s not too late to invest. If they have invested, being aware of what is covered, who to contact to initiate the insurance claim, and what services your parent will want to take advantage of is important to know ahead of time and can save money and hassles if/when the time comes.

6. What kind of care situation do you want?

Does your parent have a retirement or assisted living home in mind?  Do they want to stay at home as long as possible, focusing on ageing in-place (Home Care)? What nursing homes are they comfortable with if the situation were to become necessary? Having these discussions before a decision needs to be made ensures that people can look for the right care, make any needed arrangements, and not scramble at the last minute and have to take whatever is available.

7. What are your wishes for a funeral/memorial?

IOC-The talk2Sometimes there’s a lot of pressure to do things in a “traditional” way when it comes to how we remember our loved ones, but that’s not always what they want.  Although funerals/memorials need to reflect both the person that is gone and those who are left behind, having a discussion ahead of time can mean that all sides get their voices heard.  When a decision is reached beforehand, our loved ones know their wishes will be respected and those of us left behind can know we’re memorializing our parents in a way that they accept as well. This means no guilt for anyone and that’s a much-needed relief at a time of sorrow.

However hard it may be, please take the time to talk to your loved ones about these issues.  It’s also not too late to start thinking about them for yourself as well. The more prepared you are, the easier it is for those around us and the more open we are, the more likely we are to respect everyone’s wishes and know that ours will be respected too.

5 Things you should know about dementia

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Dementia21 – Dementia is not a natural part of ageing

When someone becomes forgetful or confused, friends are often quick to reassure them that this is just ‘what happens when you get older’. Some of us do struggle with our memory as we age or during times of stress or illness. But dementia is different. Lots of people momentarily forget a friend’s name – someone with dementia may forget ever having met them. They usually experience a range

of other symptoms alongside memory problems and will begin to struggle with daily life. Dementia is not a normal part of ageing. It’s caused by changes to the structure and chemistry of the brain.

Dementia doesn’t just affect older people. Younger people are also susceptible have dementia. This is called early-onset or young- onset dementia.

The chance of developing dementia increases with age. One in 14 people over 65 – and one in six people over 80 – has dementia. It’s more common among women than men.

Help and support:  If you are worried about your memory, or about someone else, the first step is to make an appointment to see the GP. The GP can help rule out other conditions that may have symptoms similar to dementia and that may be treatable. These include depression, chest and urinary infections, severe constipation, vitamin and thyroid deficiencies and brain tumours. The earlier you seek help, the sooner you can get the information, advice and support you need.

2 – Dementia is caused by diseases of the brain

The word dementia describes a group of symptoms that may include memory loss, difficulties with planning, problem-solving or language and sometimes changes in mood or behaviour.

What causes dementia? Dementia occurs when the brain is damaged by a disease. There are many known causes of dementia. The most common is Alzheimer’s disease. This changes the chemistry and structure of the brain, causing the brain cells to die. The first sign is usually short-term memory loss.

Other types of dementia include vascular dementia, mixed dementia (Alzheimer’s disease and vascular dementia), dementia with Lewy bodies and frontotemporal dementia (including Pick’s disease). Each of these diseases affects the brain in slightly different ways. For example, Alzheimer’s disease tends to start slowly and progress gradually, while vascular dementia following a stroke often progresses in a stepped way.


Everyone’s dementia is different: Whatever type of dementia a person has, everyone will experience the condition in their own way. How it affects a person over time is also unique to the individual – their own attitude, relationships with others and surroundings will all have an impact.

People often associate dementia with memory loss. And it does often start by affecting the short-term memory. Someone with dementia might repeat themselves and have problems recalling things that happened recently – although some people easily remember things from a long time ago. But dementia can also affect the way people think, speak, perceive things, feel and behave.

Common symptoms: Dementia often causes difficulties with concentration, planning and thinking things through. Some people will struggle with familiar daily tasks, like following
a recipe or using a bank card. Dementia also makes it harder to communicate.
For example, a person with dementia might have trouble remembering the right word or keeping up with a conversation. Many people have problems judging distances even though their eyes are fine. Mood changes and difficulties controlling emotions are common too. Someone might become unusually sad, frightened, angry or easily upset. They could lose their self-confidence and become withdrawn.

As dementia progresses: Dementia is progressive, which means that symptoms gradually get worse over time. How quickly this happens varies from person to person – and many people stay independent for years. Dementia is a condition that can affect anyone regardless of background, education, lifestyle or status.

There’s no known cure for dementia, but there are ways to help with symptoms and make life better at every stage. The more we understand about the condition, the more we can do to help people stay independent and live the life they want for as long as possible.

4 – It’s possible to live well with dementia

Scientists and researchers are working hard to find a cure for dementia. In partnership with people with dementia and their families, they are also looking into its causes, how it might be prevented and diagnosed earlier, and how to improve quality of life for people living with the condition.

Until we find a cure, there are drugs and other therapies that can help with some of the symptoms, so people can lead active, healthy lives and continue to do the things that matter to them most.

Drug treatments: There are medications available that may help with some types of dementia and stop symptoms progressing for a while. This is one reason it’s important to go to the doctor as soon as you suspect there’s a problem. It can feel like a big step to take, but a diagnosis can open up many opportunities to help overcome problems and find better ways of coping.

Non-drug treatments: People with dementia can also benefit from approaches that don’t involve drugs. For example, life story work, in which the person is encouraged to share their experiences and memories, or cognitive stimulation, which might involve doing word puzzles or discussing current affairs. Keeping as active as possible – physically, mentally and socially – can really help. It can boost memory and self-esteem and help avoid depression.

Dementia35 – There’s more to a person than the dementia

Living with dementia is challenging. When someone is diagnosed, their plans for the future might change. They may need help and support with everyday tasks or to keep doing the activities they enjoy. But dementia doesn’t change who they are. With the right support, it is possible for someone with dementia to live well and get the best out of life.

‘It’s important to carry on doing the things you enjoy, and not sideline yourself from your friends and family. We still go to the pictures and to the theatre.
We keep in touch with family and friends. We still go on holiday. We still go out together and do the things we always did.’ Brenda, whose husband has dementia

‘The art classes, choir and Memory Café are all brilliant for boosting my confidence. I’ve come away from my art classes and choir practice feeling like I’ve really achieved something. The choir has helped with my speech and memory too – I’m amazed that I can remember all the songs.’ Linda, living with dementia

‘Mum still does the things she used to do regularly – she still takes the dog to the woods like she used to. If she does something regularly and carries on doing it, she doesn’t normally forget it. Routine is really important.’ Pip, whose mother has dementia