Preventing and Managing Delirium

Delirium is the term used to describe an acute confusional state that is characterised by disturbances in consciousness, altered cognition and has a fluctuating course. It generally develops over 1-2 days and can be present at the time of a person’s hospital admission. It can also develop at anytime during  a hospital admission

Who is at risk of having delirium?

All hospital in patients are at risk of developing delirium. However the greatest risk is in elderly patients, patients with pre existing cognitive impairment, patients with hip fractures and patients with a severe illness including ITU patients.

What is not delirium?

Dementia is not delirium. However at the time of admission it may be difficult to distinguish this. In such a situation the person should be managed as having delirium.

Why is it important to detect it?

Delirium is associated with poor outcomes. People who develop delirium tend to have:

• A longer period of stay in hospital
• Increased risk of hospital acquired infections
• Increased risk of developing dementia
• Increased risk of complications such as falls and pressure sores
• Increased risk to needing long term care placement
• Increased risk of death.

How do you prevent it?

It is important to identify and treat delirium early. At the time of admission all patients should be assessed for the presence of delirium. This should take into account those people who are at an increased risk i.e. people over the age of 65 years, patients with a pre existing dementia, hip fracture patients and patients with a severe illness.

How do you manage it?

The management of delirium depends on the cause. Staff can follow this pathway and checklist to appropriately manage patients.