Clinical update

Delirium

Read our clinical update on an RCN campaign to help nurses spot the signs of delirium.


Picture: Alamy

Essential facts

Delirium is a state of heightened mental confusion that mainly affects older people. The serious condition typically develops over one to two days and is associated with poor outcomes. People who have delirium have increased risk of needing long-term care and developing more hospital-acquired complications such as falls and pressure ulcers. It is also associated with higher mortality rates. However it can often be prevented and treated if dealt with urgently.

What’s new

The RCN has launched a drive to help nurses spot the signs of delirium in order to improve care and save lives. Delirium champions will educate colleagues on the signs and symptoms to look out for and encourage early diagnosis. It is aimed at nursing staff in the community and care homes to try and prevent people becoming seriously unwell and needing hospital care.

Signs and symptoms

Signs of delirium can be vague and difficult to identify. Delirium can be hyperactive or hypoactive, but some people show signs of both. These can include being more sleepy than normal, hard to wake up, more confused and having slow responses. Signs can also include being more active or alert than normal, seeing or hearing things, paranoia, being withdrawn, a change in attitude and communication, being restless and agitated, not eating and sleep problems.

Causes and risk factors

People are at higher risk if they are aged 65 years or older, have cognitive impairment and/or dementia, a current hip fracture or a severe illness. The onset of delirium always indicates the presence of a physical disorder or acute illness.

How you can help your patient 

Consider delirium when caring for older people whose behaviour seems different. Escalate concerns rapidly. Avoid moving people between wards or in rooms unless absolutely necessary.

Within 24 hours of admission to a care setting, assess people at risk for clinical factors contributing to delirium. Based on these results, provide a multicomponent intervention. This could include addressing dehydration, constipation, assessing and treating pain, checking for and treating infections, addressing immobility and addressing cognitive impairment or disorientation.

Expert comment

 Dawne Garrett, RCN professional lead for older people and dementia care

‘Delirium is a very serious and complex condition that can have a major impact on patient outcomes. A lot of work has been done in hospitals on recognising delirium and the main focus of the new RCN delirium champions is raising awareness among colleagues in the community. As nurses in the community and care homes often see patients regularly they are in a good position to spot the condition early. The main message is that if there is a change in someone’s behaviour over a couple of days then consider the possibility of delirium. Part of the work of the champions will be clarifying or developing a local escalation plan, so that there is a clear pathway for patients causing concern.’

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