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Acute Confusional State (ACS) or Delirium

Sindrome confusional agut  Vall d'hebron

 

Delirium, or ACS, is a potentially serious acute condition affecting concentration and cognitive function that is common among elderly patients admitted to hospital. Patients with the condition may decline during their stay in hospital.

There are many causes of this condition in the elderly and being admitted to hospital may often be one of them, due to the change in surroundings the person experiences.

This change in mental state is characteristically acute and fluctuating, although if appropriate interventions are carried out it may be totally or partially reversed, or even prevented.

 

Description

What causes ACS or Delirium?

 

Infections, surgical procedures, dehydration, pain, prior cognitive deterioration, lack of mobility, restricted movement, wearing a catheter or probes, environmental factors, and some medication may trigger delirium.

 

 Signs and symptoms in patients with ACS or Delirium

 

They may show one or more of the following symptoms:

  • Not knowing where they are.
  • Incoherent speech.
  • Not recognising the people around them.
  • Being unable to stay still.
  • Seeing or hearing things that are not there.
  • Being more drowsy than usual.
  • Becoming agitated at night.
  • Alternating between agitation and drowsiness.

The person may not understand what is said to them. They may appear distrusting or irritable with those they know. At other times, they may appear normal (fluctuation).

 

 

How is it treated?

 

The medical team will analyse the possible causes of delirium and will take the appropriate measures for each patients such as diagnosis and treatment of any infections; pain management; rehydration; reviewing treatment, catheters and sensors, etc.

Medication to control the delirium may sometimes be necessary, which will make the person calmer and more cooperative and less likely to have an accident or injure themselves.

 

 

How can the family of a patient with ACS or Delirium help?

 

The family's involvement is essential to prevent complications associated with ACS or delirium.

 

Recommendations:

 

  • Tell the healthcare staff about any symptoms they observe such as: disorientation, agitation, confusion or reduced personal interaction.
  • Make sure the person is accompanied by a trusted friend or family member whenever possible, especially during the first 48 hours in hospital. This will make them feel safe and calm.
  • Talk to them using simple clear language in a soft and calm tone of voice. Don’t argue with them and explain things calmly.
  • When leaving at night and the person is to be alone, ask the nursing team to leave the night light on so they know where they are if they wake up.
  • Check they have enough light during the day time.
  • Make sure they have their glasses or hearing aids, if they use them. This will help them feel safe.
  • Explain to them where they are and what has happened to them. Bring items to help them remain connected to the present (a watch, calendar, etc.)
  • Encourage them to move whenever possible (short distances) and to do things for themself (getting dressed, eating, etc.)
  • Try to ensure the person with delirium doesn't sleep during the day by talking to them, reading aloud from a book, magazine or newspaper, etc. This will help them to sleep at night.
  • It is useful to bring them personal items, such as photos, a radio with headphones so as not to disturb other patients, etc. This will help keep them orientated and occupied.
  • It is a good idea to limit the number of visits they receive until the delirium has passed.
  • You can consult the nursing team with any questions you may have. 

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