Delirium

Delirium

Delirium is a common condition that affects patient’s thoughts and behaviours for a period of time. Delirium often has many causes and it can be difficult to recognise and treat. Sometimes the cause is not found. It can be distressing and frightening for patients and for their friends and relatives. Approximately 20% of all patients admitted to hospital become delirious at some time during their stay.

Causes
These include pain, infection, constipation, poor nutrition and hydration, sleep deprivation, changes of environment, blood test abnormalities and medications.

Who is at risk of delirium?
People Who:

• Are Older – The risk increases with age
• Have Dementia/Cognitive decline
• Have had recent surgery especially for a hip fracture for example
• Have neurological problems such as stroke, Parkinson’s disease or a head injury
• Are dehydrated
• Have an infection
• Take lots of different medications
• Consume excessive amounts of alcohol or take illegal drugs
• Are severely ill
• Have poor hearing or eyesight
• Are nearing the end of their life

Is it the same as dementia?
No. Delirium is not the same as dementia, although people living with dementia are more likely to get delirium. Dementia is a longer term loss of memory and other aspects of thinking, which usually progresses over time.

What is it like to have delirium?
You may:

• Be less aware of what is going on around you
• Be disorientated to time and place
• Be unable to follow a conversation or to speak clearly
• Have vivid dreams, which are often frightening and may carry on when you wake up
• Find that your mind plays “tricks” on you e.g. Hear things when there is nothing or no one to cause them and/or see people or objects which aren’t there
• Worry that other people are trying to harm you
• Be very agitated or restless, unable to sit still and wandering about
• Be very slow or sleepy
• Sleep during the day but wake up at night
• Have moods that change quickly; you can be frightened, anxious, depressed or irritable
• Be more confused at some times than at others – often in the evening or at night

Why is it frightening?
Delusions and hallucinations are often frightening. Delirium itself can also cause anxiety or fear.

Delusions are false beliefs that the individual is convinced are true. The person may think that someone is trying to harm them; that people are not who they say they are or that the surroundings have been altered. The beliefs can be quite short lived, or change a lot from time to time. For the individual suffering them these thoughts they have are very real. They can bring on suspicion, mistrust or accusations towards family, friends or hospital staff. Afterwards it can be difficult to separate what was real from what was not.

Hallucinations are usually visions but can also be voices or skin sensations. They may be formed and moving (like insects, animals or people) or sometimes shapes or lights. The visions may merge with real objects or appear to come out of walls, curtains or pictures and are often worse at night

How can I help someone with delirium?
You can help someone with delirium feel calmer and more in control if you:

• Stay calm.
• Talk to them in short, simple sentences.
• Check that they have understood you – repeat things if necessary.
• Try not to agree with any unusual or incorrect ideas but tactfully disagree or change the subject.
• Reassure them.
• Remind them of what is happening and how they are doing.
• Remind them of the time and date.
• Try to make sure that someone they know well is with them. This is often most important during the evening when confusion often gets worse.
• If they are in hospital bring in some familiar objects from home.
• Make sure they have their glasses and hearing aid.
• Help them to eat and drink.
• Have a light on at night so that they can see where they are if they wake up.

How long does it take to get better?
Delirium can get better when the cause is treated. You can recover very quickly but it can take several days, weeks or longer in some cases. People with dementia can take a particularly long time to get over delirium. Once you’ve had one episode of delirium you are more likely to get it again if you become medically unwell.

Going home after an episode of delirium.
Sometimes, periods of delirium can continue ‘on and off’ for a period of time after discharge home (although often being in a familiar environment is actually beneficial to recovery). If this happens, you should contact your relative or friend’s GP for advice. Some people need time to make sense of their experience of having delirium after they return home. You can help by listening and ‘filling in any gaps’ in their memory.

Contact details
If you have any specific concerns that you feel have not been answered and need explaining, please speak with the Doctor or Nurse in Charge.

If you feel that your concerns have not been addressed you can ask to see a manager or matron. If you still have concerns our Patient Advice and Liaison Service (PALS) can provide you with independent support and advice. PALS is contactable on 0300 123 1733.

If you wish to make a formal complaint you can:
Write to our Chief Executive at Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD
Or Contact our Complaints Team on 0300 123 1732 or by email at wah-tr.PALS@nhs.net

Other information
The following organisations / websites provide information that you may find useful.

The Alzheimer’s Society provides advice and support on all forms of dementia.
Helpline Tel: 0300 222 11 22
Worcestershire Office Tel: 01905 621 887
Email: worcestershire@alzheimers.org.uk

Carers UK provides information and support for carers
Tel: 020 7378 4999 Website: www.carersuk.org

Worcester Association of Carers
Provides information and support for local family’s and their carers
Tel: 0300 12 4272
Website: www.carersworcs.org.uk

Age UK provides advice, support and information for older people
Worcester Office
Tel: 0800 008 6077 Email: office@ageukhw.org.uk
National Office
Tel: 0800 678 1174 Website: www.ageuk.org.uk

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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