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Nurses should be delirium champions and identify people at risk as early as possible

Delirium is an acute deterioration in mental function that commonly affects older people, but many risk factors can be mitigated 
Picture of an older man in a hospital gown. Delirium is an acute state of confusion that commonly affects older people, but many risk factors can be mitigated and nurses need to be knowledgeable about it, says Vicky MacRae.

Delirium is an acute deterioration in mental function that commonly affects older people, but many risk factors can be mitigated, says a delirium nurse

Delirium is one of the most common conditions seen by nurses. It can affect all age groups and cross all specialties. Whether young or old, it is an unpleasant experience.

However, for older, frailer patients delirium can have life-changing consequences, such as a reduction in functional ability, cognitive decline and sometimes admission to long-term care.

Many areas of care are still failing to recognise or are misdiagnosing delirium, particularly in the older population, where symptoms are often considered to be a normal part of ageing or confused with dementia.

Identify people at risk of delirium at an early stage and plan care

In many acute areas delirium is often only identified when a patient

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Delirium is an acute deterioration in mental function that commonly affects older people, but many risk factors can be mitigated, says a delirium nurse

Picture of an older man in a hospital gown. Delirium is an acute state of confusion that commonly affects older people, but many risk factors can be mitigated and nurses need to be knowledgeable about it, says Vicky MacRae.
Picture: iStock

Delirium is one of the most common conditions seen by nurses. It can affect all age groups and cross all specialties. Whether young or old, it is an unpleasant experience.

However, for older, frailer patients delirium can have life-changing consequences, such as a reduction in functional ability, cognitive decline and sometimes admission to long-term care.

Many areas of care are still failing to recognise or are misdiagnosing delirium, particularly in the older population, where symptoms are often considered to be a normal part of ageing or confused with dementia.

Identify people at risk of delirium at an early stage and plan care

In many acute areas delirium is often only identified when a patient is visibly experiencing stress and distress symptoms, and by that time the patient and family can be in crisis.

With World Delirium Awareness Day on 11 March focusing on ‘Stopping delirium before it starts’, it’s time we all became proactive delirium champions by identifying those at risk at an early stage in hospital and planning care around this.

RCNi delirium articles

As a delirium nurse for NHS Ayrshire and Arran, risk reduction is high on my agenda and it was the focus of the recent SIGN guideline. Screening tools and management checklists are well embedded in everyday practice.

Several risk factors contribute to the development of delirium

Robust educational programmes and simulated training sessions are available to all healthcare professionals, and we have many nurses championing the delirium cause.

But can we do more? Several risk factors contribute to the development of delirium and many can be mitigated to reduce its incidence. While there is no evidence that the environment alone can cause delirium, the condition may be exacerbated by certain environmental issues.

Everyone has a part to play in helping patients feel more comfortable and settled in hospital, and this is an integral part of delirium management. Providing clocks and calendars, obtaining familiar possessions, avoiding bed moves and staff changes all help to ensure orientation and safety.

Sensory deprivation is common in hospitals, with some rooms providing little natural light and older patients are often already deprived by sight or hearing loss. Combined with other risk factors in the hospital environment such as alterations in sleep patterns, pain, sedation and polypharmacy, these changes can contribute to the development of delirium.

Simply ensuring the patient has the correct spectacles, working hearing aids and a quiet, safe environment can improve outcomes.

Early identification will allow nurses to implement prevention strategies

Delirium may be an unknown term for the layperson. It can be a psychologically traumatic experience, and the education of patients, families and carers is paramount. Encouraging care participation can alleviate relatives’ sense of helplessness and anxiety.

Giving people the correct information about the specific and sometimes disguised symptoms of delirium will help them identify acute changes more swiftly.

Many risk factors for delirium are controllable, and prevention is vital to reducing the incidence. Nurses need to be knowledgeable about the signs and symptoms of delirium. Early identification will allow nurses to implement prevention strategies and provide vulnerable patients with the chance of a delirium-free hospital experience.


Picture of Vicky MacRae, a delirium nurse at NHS Ayrshire and Arran. She says many risk factors for ddelirium can be mitigated, and nurses need to be knowledgeable about it.Vicky MacRae is a delirium nurse at NHS Ayrshire and Arran

 

 


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