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What carers of people with dementia need to know about delirium
- 1. A talk for World Delirium Awareness Day 2022 Dr Shibley Rahman Honorary research fellow Institute of Cardiovascular Science University College London (UCL) 12 March 2022
- 2. Delirium is the canary in the mineshaft
- 3. frightened
- 4. uncertain
- 5. exhausted
- 8. March 2020
- 10. ‘This is not my mum’ https://www.thisisnotmymom.ca Ken Rockwood in Canada
- 12. What is delirium? Delirium is a medical condition that causes a temporary problem with mental function. In older adults, delirium is often the presenting symptom of another underlying illness. ‒ multiple causes ‒ begins quite suddenly over hours or days ‒ symptoms tend to come and go ‒ a medical emergency and early diagnoses and treatment offer the best chance of recovery ‒ https://www.thisisnotmymom.ca/what-is
- 13. Common symptoms ‒ sleepiness ‒ confused ‒ tearful ‒ anxious ‒ suspicious ‒ restless ‒ disorientated ‒ distractible ‒ https://www.thisisnotmymom.ca/what-is
- 14. Treatment goals ‒ the prevention of delirium in patients with dementia is the primary goal; ‒ adequate food and drink; ‒ avoiding constipation; ‒ avoiding dehydration; ‒ vigilance about smelly urine; ‒ aiming for ‘good sleep’; ‒ Glasses and/or hearing aids
- 15. In and out of hospital
- 16. Triangle of care
- 17. Rahman and Byatt (2021)
- 18. Shrestha and Fick (2020) ‒ important care partners ‒ have limited knowledge about delirium ‒ value information from healthcare professionals ‒ want to be heard and be involved.
- 19. Gibb K et al. What prompts patients to present with delirium? Eur Geriatr Med. 2021 Jun;12(3):643-651. ‒ 60 patients were included (mean age 85, SD 6.8 years). ‒ Reported symptoms included drowsiness and lack of responsiveness, though these were less commonly recognised as being due to delirium. ‒ 76% received medical advice within 24 h, although two responders took > 1 week. One-third of responders had never heard of delirium.
- 20. Non-specific symptoms of constipation ‒ Feelings of nausea ‒ Bad breath ‒ Bad taste in the mouth ‒ Reduced appetite ‒ Lethargy ‒ Restlessness
- 21. Moore et al. (2020)
- 22. Moore et al. (2020) ‒ Infection is common in older adults. ‒ What prompts older patients to seek medical advice? ‒ Interviews in Oxford. ‒ 28 participants took part. ‒ Several early non-specific symptoms were described (fever, feeling unwell, lethargy, vomiting, pain, and confusion/delirium).
- 24. Carers are important ‒ Younger age of patient and a longer time from delirium detection to consultation associated with the depressed mood of carers (Kim et al., 2021). ‒ Family carers reported to feel more competent and equipped to deal with the patient's delirium symptoms (McKenzie and Joy, 2019).
- 25. Mossello E et al.. Family and healthcare staff's perception of delirium. Eur Geriatr Med. 2020 Feb;11(1):95-103.
- 26. Delirium and family carers, in various settings ‒ In ICU, unfamiliarity and lack of knowledge about intensive care and patient treatments were a source of family cares' perplexity (Huang et al., 2022). ‒ Families are devastated to witness their loved ones behaving erratically or even violently (Ryan and Kimchi, 2021).
- 27. Networks of the brain
- 29. Rahman, Deeley and Mehta (2022) ‒ Calls for listening to the patients’ and carers’ experiences much better ‒ Impossible to know which neural networks are involved otherwise
- 30. Rahman (2021)
- 31. Further reading
- 32. Thank you!