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Could it be delirium?

An RCN campaign to reduce the effects of delirium on older people stresses the need for swift action at the first signs of confusion

An RCN campaign to reduce the effects of delirium on older people stresses the need for swift action at the first signs of confusion


An image from the RCN video on Delirium Champions.

Taking swift action when an older person first shows signs of becoming confused or acting differently from usual can make a huge difference to their future health.

Raising awareness of this message is the focus of an RCN campaign to reduce the potentially devastating effects of delirium on older people.

Delirium is a serious but often-missed condition of heightened mental confusion that mainly affects those over 65 and can lead to a higher risk of death or admission to long-term care.

Potentially reversible

While half of cases are potentially reversible, prompt identification and treatment are needed.

The delirium champion campaign led by the RCN older people’s forum has been shining a spotlight on the condition to increase understanding and, crucially, boost diagnosis in the community.

‘We are trying to push for people in the community to consider delirium earlier and get treatment sooner’

Vicki Leah, chair of the RCN older people's forum

Chair of the RCN older people's forum Vicki Leah says the campaign was launched after emergency department nurses repeatedly saw patients arrive with delirium and in very poor health.

Don’t dismiss it

‘People are going into hospital who have clearly been delirious for a long time,’ says Ms Leah, nurse consultant for older people at University College London Hospitals NHS Foundation Trust.

‘So we are trying to push for people in the community to consider delirium earlier and get treatment sooner, rather than waiting for something catastrophic to happen like a fall or a broken hip.’

Sudden confusion should not be dismissed as a sign of old age, Ms Leah says. ‘We want healthcare and other staff to think “this person has changed” and ask themselves if it could be delirium,’ she says.

Delirium champions

Older people and people with dementia, severe illness or a hip fracture are more at risk of delirium. Up to 30% of patients on medical wards have the condition, and between 10% and 50% of people having surgery develop delirium. But the National Institute for Health and Care Excellence (NICE) cautions that the figures are likely to be higher.

People with delirium are more likely to die, have hospital-acquired complications such as falls and pressure ulcers, need critical care, have increased length of stay and be less likely to be able to live independently subsequently.

The RCN campaign involves training local nurses and other staff to become delirium champions in their workplace. They then raise awareness of delirium, giving other staff the tools to recognise its early signs and emphasise the need to escalate concerns about delirium to prevent harm.

Education sessions

Champions are encouraged to run 20-minute education sessions with an RCN video that prompts staff to consider delirium for a patient, client or resident who seems different.

So far there are more than 90 delirium champions and almost 2,200 people have received training across acute and community settings. This includes nurses, nursing students, midwives, paramedics, pharmacists, hospice staff, care home and catering staff, and care home residents.

Of the almost 40 evaluations received by the RCN from champions so far, 97% are positive, almost half had run more than one session and almost 60% planned to run more.

Team of nurse educators

Northern Devon Healthcare NHS Trust has enthusiastically embraced delirium training. The trust has a team of nurse educators who work with local care homes to deliver training on important care issues.

Nurse educator Martine Butler, a delirium champion, has delivered training to staff at 18 care homes and services in just three months. She has combined aspects of delirium training into a package that includes sepsis and the importance of swift escalation of concerns.

‘Now staff are much more confident and for us the delirium training has been fantastic’

Simone Dunford, care home manager

‘We target education at the people who are at the coalface, doing the care,’ she says. ‘One of the aims of the session is a call for staff to know their residents and their service users. It is about being person-centred, knowing residents’ life stories and behaviours, so they can pick up on those subtle changes. Subtle shifts can indicate something catastrophic. If there is something different then escalate it.’

Staff are more confident

The benefits of the training have been quickly experienced at Susan Day Residential Home at Ilfracombe in Devon, when staff acted quickly in the case of a resident who they thought might have delirium. The care home had recently had a well-attended training session for staff and two residents, and had put in place recommended delirium escalation plans for residents.

So staff acted quickly when they became concerned about a resident and promptly contacted a GP. The doctor came to the home and sent the resident to hospital, where they were diagnosed with sepsis and successfully treated.

Care home manager Simone Dunford says: ‘It all happened within five or six hours, as we were much more aware of and attuned to look at small things we might otherwise not have thought about. The doctor was impressed with how quickly we had responded. Now staff are much more confident and for us the delirium training has been fantastic.’


The RCN campaign involves training local nurses and other staff to become
delirium champions in their workplace.

Identifying the types of delirium

  • Delirium is a serious condition that causes disturbed consciousness, cognitive function or perception. It is associated with poor outcomes and usually develops over one to two days.
  • Delirium can be hypoactive or hyperactive, but some people show signs of both.
  • People with hyperactive delirium have heightened arousal and can be restless, agitated and aggressive.
  • People with hypoactive delirium become withdrawn, quiet and sleepy.
  • Hypoactive and mixed delirium can be more difficult to recognise.
  • It can be difficult to distinguish between delirium and dementia, and some people may have both conditions. If there is clinical uncertainty about the diagnosis, the person should be managed initially for delirium.
  • Most people in care homes are at risk of developing delirium.

Source: NICE guidance Delirium: prevention, diagnosis and management


Erin Dean is a freelance health writer

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