March 15, 2017

Delirium awareness promoted by Vanderbilt physicians

Today is the inaugural World Delirium Day, created to raise delirium awareness and inspire positive action among health care providers.

Today is the inaugural World Delirium Day, created to raise delirium awareness and inspire positive action among health care providers.

One out of four older people in the hospital experience delirium, an illness with the same death rate as having a heart attack; however, it is often undetected and under treated.

Delirium is a manifestation of acute brain organ failure and can cause sudden and severe decline in mental function. While the elderly are more prone to delirium, anyone, even children, can experience delirium.

The impact of delirium is significant including being in hospital longer, losing independence, having long-term memory loss, mood changes such as anxiety and depression and increased incidence of death.

Unfortunately, most people with delirium do not receive proper care and families are not given accurate information about what is happening to their loved one.

Knowing these facts, health care providers from the American, European and Australian Delirium societies, are recognizing the inaugural World Delirium Day today to promote more education about delirium.

Their mission is to raise delirium awareness and inspire positive action among health care workers and the community to prevent, increase early detection and care for people with delirium. Health care organizations, professionals and consumers are encouraged to take action to raise delirium awareness, and unite on social and internet media to show support for this important initiative.

“Delirium occurs in a significant proportion of patients, yet is a frequently under-diagnosed condition in patients in hospitals and residential aged-care facilities across the world. Up to 80 percent of episodes are missed,” said Pratik Pandharipande, M.D., MSCI, chief of the Division of Anesthesiology and Critical Care Medicine at Vanderbilt University Medical Center. “Longer durations of delirium in the hospital and ICU have been associated with worse outcomes including increased odds of newly acquired cognitive impairment and death. It is therefore so important to be educated on delirium and how to detect and manage it in our patients.”

Those with delirium experience disorientation, inattention, change in level of awareness or increased drowsiness, restlessness, hallucinations, or becoming paranoid. Delirium is caused by a wide range of common medical illnesses, injury, surgery or medicines.

At present, there are no effective drugs to treat delirium. The best approach is to prevent delirium before it occurs (through improving mobility, hydration and other non-drug strategies) or detecting it early. When delirium does occur, nurses, doctors and other health care team members can identify and treat underlying causes and support recovery.

What is Delirium?
Delirium is a very rapid decline in brain function. It involves a mix of: reduced ability to concentrate, sleepiness, agitation, hallucinations or altered beliefs. Delirium develops over hours or days.

What Causes Delirium?
Delirium is caused by illness, injuries (like a broken bone after a fall), surgery or medicines.

Who gets delirium?
Anyone can get delirium. Older age and dementia greatly increase the chance of becoming delirious.

Is delirium the same as dementia?
Delirium is different from dementia. Delirium comes on quickly and usually resolves over days. Dementia develops slowly (months) and mostly cannot be reversed.

If it can be reversed, what is the big deal?
Even a brief course of delirium increases the risk of poor recovery from illness, nursing home placement, and possibly dementia and death. Delirium is stressful for patients with frightening beliefs like thinking they are in prison and in danger. Families and caregivers are distressed by delirium as well.

How common is delirium in the hospital?
One out of four older patients and up to three out of four ICU patients can be affected.

How is delirium treated?
Promptly targeting the underlying illnesses or adjusting medications that may have triggered delirium are the most important treatments.

My nurses and doctors know about delirium, right?
Delirium is still undiagnosed in a majority of cases. Unfortunately, not all health care professionals know enough about delirium.

What can I do about delirium?
Seeking medical help promptly: delirium can be a sign of acute, serious illness.
During delirium, recovery may be helped by:
• Making sure glasses and hearing aids are used
• Getting up and out of bed
• Reassurance, re-orientation and avoidance of conflict
• Allowing night-time sleep
• Gentle conversation, playing games doing puzzles.