Delirium, an all too common and confronting experience for older people throughout Australian hospitals.
It is estimated that at any one time, 50% of older people could have a delirium: Reported or unreported. By this we are referring to the fact that despite delirium being so common it is often misdiagnosed, overlooked or poorly managed throughout hospital systems.
As a result many older people experience additional complications of incidents as a result such as falls, incontinence, dehydration, infections, dehydration and pressure injuries. Delirium occurs as a result of a chemical imbalance in the brain, impairing normal sending and receiving signals.
Delirium is serious and should be treated as a medical emergency. The unfortunate fact however, it is a condition that it is often not treated seriously enough.
In addition to this when we look at patients admitted with a preexisting cognitive impairment, their new symptoms are often not explored entirely and in effect labelled with pre-existing mild cognitive impairments, Alzheimer’s or other forms of dementia.
What is evidently clear, everyone involved in the hospital system, from clinical, non-clinical and visitors have a role to play to support older patients that present to ensure that they are delivered the very best, true meaning of words ‘person centred care’.
Let’s take a closer look at each group of people in the hospital system and how we can be more aware of the signs to look out for and where necessary report.
Despite the condition being around since the mid 1800’s, many nurses and clinicians often fail to identify their earlier warning signs and serious nature of delirium. That coupled with a diagnosis of dementia, the patient, too often presumed to have behaviours of symptoms directly related to their dementia. When in effect the clinician’s role is to distinguish between acute delirium and other cognitive decline.
The management of cognitive impairment and dementia in the acute is a systemic problem, not isolated to one hospital. Historically cognitive impairment and delirium have not been a priority. Well, at least not until more recently, The National Safety and Quality Health Service Standards (NSQHSS) released a ‘Better Way to Care- Cognitive Impairment’, putting cognition and delirium not just on the agenda but a committed priority. It’s anticipated that by 2017 the management of Cognitive Impairment will be a standard that hospitals must comply with during the accreditation period.
Whilst on a whole hospital staff do the best they can with the resources and training they have been provided. There is much more however that needs to be done in way of screening patients, education for staff and awareness. A study performed by Professor Mark Yates, from Ballarat Health Service revealed that hospital staff in many cases have never received adequate training on cognitive impairment. With eighty to ninety percent of hospital staff reporting difficulty when caring for patients with cognitive impairment. These figures, reflecting of the management of cognitive impairment in the current system today.
If you are working in the acute setting or you have a elderly family member or friend that potentially could be admitted to hospital we suggest checking out these excellent resourcesl
Shifting the mindset, educating non-clinical and clinical staff to be aware of early signs of delirium and how to effectively manage people with cognitive impairment should be a key priority for all hospitals. Recognising an acute change in behaviour, sleep pattern or reporting symptoms of increased fatigue promptly can be one of the best things a clinician could do to support older people.
By not assuming the patient’s clinical presentation is a normal pattern for them, for example confusion, agitation, paranoia, inability to complete tasks, and or insomnia- warning signs if reported early are the most effective. If unsure s peak with the best resource. The person’s next of kin.
As mentioned we all have a role to play in the system. The family’s role in this case is one of the most important. The nurse or doctor does not know your loved one, like you do. It may be the first time they have ever cared for them also.You role is critical. Clinician’s need to hear exactly how your loved one was functioning physically and cognitively before admission. Over what period you have noticed a decline in their abilities, what is normal for them and what is not. As this will help make a more accurate and hopefully quicker diagnosis. You are their advocate, you are their voice when they cannot communicate articulately or report what has been happening. Don’t feel as though you are being a ‘difficult family’. Nothing else matters but the welfare for your loved one, so speak up and be sure you are listened to.
Hospitals, by nature are difficult environments for people with delirium, dementia or cognitive impairment but we should all do our best in our community to make them more friendly to support our ageing community.
This training video, created by Geriatric Medicine Research & Spider Video for Dalhousie University Medical School, shows some common scenarios that doctors may encounter when an older patient is admitted with delirium, and how to correctly identify it in your patients.