Delirium prevention is everyone’s responsibility
Delirium is a common condition, which can have short- and long-term complications, however it can be difficult to identify.
The prevention of delirium and complications associated with delirium is the research focus of Laurie Grealish, Associate Professor of Subacute and Aged Nursing (Menzies Health Institute Queensland and School of Nursing and Midwifery), Griffith University and Gold Coast Hospital and Health Services.
“Our work is focused on how health professionals can make small changes to their practice which have a big impact on patient outcomes,” she said. “We do this through testing new forms and procedures, and engaging the staff in the whole process of research, so that they own the projects and more actively learn about delirium prevention.”
Most recently, A/Prof Grealish said they are developing an interest in the care of people living with dementia, who are at the highest risk of developing delirium.
“In this work, we are focused on improving nurses’ knowledge of the person’s needs and interests and how this can support physical, social and cognitive engagement required to prevent delirium.”
Like pain, delirium is a sign that something is wrong in the body and requires immediate evaluation by a medical professional. For example, people with dementia might get delirium with a urinary tract infection, and therefore that infection must be treated for the delirium to be resolved.
The challenge for health professionals is that detecting delirium is complicated by the many ways it can present.
A/Prof Grealish said delirium can be hyperactive, with the person speaking in incomplete or unrelated sentences or experiencing
hallucinations. If staff do not know the person, then these symptoms could be confused with other diseases such as dementia.
Delirium can also be hypoactive, where the person is drowsy and unable to engage. This state can be mistaken for tiredness, often related to an underlying medical condition, and continued rest is mistakenly recommended.
“Often hospital staff do not know the person well enough to recognise the difference in cognitive state and rely on advice from family and friends who know the person. This is more difficult if there are no visitors, such as in a pandemic,” A/Prof Grealish said.
However, it is important to be able to prevent delirium as it can have several short- and long-term complications.
For example, A/Prof Grealish said, when people experience hyperactive delirium, they may try to get out of bed quickly and experience a fall, which can cause injury. Or if the person is experiencing hypoactive delirium, they may not move enough in bed and develop pneumonia or a pressure injury.
She said that people who develop delirium in hospital also experience higher rates of death in hospital and discharge to an institution (i.e. residential aged care facility).
So how can health professionals help prevent delirium?
According to A/Prof Grealish, delirium can be prevented by continuing the person’s normal routines including activities such as walking, maintaining adequate nutrition, and being socially and cognitively engaged.
“Encouraging families to visit, chatting about current affairs, and making time to help people move around and eat enough is really important,” she said.
Delirium prevention is everyone’s responsibility. A video has been developed for families to show them how they can help to prevent delirium in hospital. See: https://www.youtube.com/watch?v=zO17H4aQpM4
Want to learn more about delirium. ANZCEN produces a range of clinically focused, modern and interactive eLearning content
exclusively for our members. Find out more: https://www.anzcen.edu.au/elearning/