Delirium

Types of patients at risk

• Elderly patients
• Those with cognitive impairment, dementia or depression
• Those who have previously suffered delirium
• Those dependent on self-care
• Those with impaired vision or hearing
• Those with various associated diseases
• Patients on treatment with multiple drugs or with a history of alcoholism

Triggers

Delirium usually involves multiple factors, but the main causes that can trigger it during hospitalisation are: 

• Infections
• Surgery
• Dehydration
• Constipation and acute urine retention
• Pain
• Immobility or restricted movement (patient with catheters and tubes)
• Environmental factors, such as hospitalisation itself
• Use of certain drugs

Signs and symptoms

They may present with one or several of the following symptoms:

• They are disoriented and do not know where they are.
• They say incoherent things.
• They do not recognise the people around them.
• They cannot stay still.
• They hear or see things that are not real.
• They are drowsier than usual.
• They get agitated at night.
• They alternate between periods of drowsiness and agitation.
• The person may not understand things that are explained to them and may show distrust or irritability towards people they know. They are incapable of following instructions.
• There may be major changes to their behaviour, and they may even develop a verbally or physically aggressive attitude. 

Inform the healthcare staff if you detect any of these manifestations in the person you are accompanying. In addition, bear in mind that the episode of delirium may last from hours to days in most cases, but it can also last for weeks or months. 

Prevention

In 40% of cases, delirium can be prevented if you follow these recommendations: 

• Orient them in time, space and person. Talk to them.
• Show them personal objects (e.g. photos, watch, calendar)
• Encourage self-care.
• If they use glasses, hearing aids or dentures, encourage their use to make it easier to interact with their environment.
• Do activities that they enjoy, such as reading, or listening to music or the radio.
• It is important for the patient’s room to be well lit, while avoiding noise and excessive visits.
• Make sure the patient is well-fed and hydrated and avoid fizzy drinks with caffeine and stimulants.

Treatment

As well as implementing non-pharmaceutical measures, the medical team and nurses will analyse the possible causes of the delirium and adopt the most appropriate measures for each patient, such as diagnosing and treating infections, controlling pain, correcting dehydration, and reviewing treatment and catheter use, among other measures.

On some occasions, it will be necessary to administer medication to help control the delirium, calm the person and make them more collaborative to remove the risk of accidents and injury.

Complications

People who suffer episodes of delirium during their hospitalisation may suffer falls, bronchospasms and loss of autonomy in activities for daily living, possibly requiring more help than before hospitalisation; they may even need to stay in hospital or another centre for longer to recover their lifestyle. 

In some cases, patients with delirium require subsequent follow-up due to the risk of developing cognitive impairment.

The role of the family

Collaboration with the family is essential, as they know the patient best and can best help to prevent some of the associated complications. 

Whenever possible, it is important for the person to be accompanied by a family member or close friend, especially in their first 48 hours of admission. This will calm and reassure them. 

If the companion has to go and leave the person alone, the nurses should be informed so they can supervise the necessary care. 

You can follow the prevention recommendations and also bear in mind the following:

• Inform the healthcare staff of any symptoms you see, such as disorientation, agitation, confusion or reduced personal interaction. 
• Explain to the patient where they are and what has happened. Bring them objects to help them feel oriented and connected to the present (e.g. a watch or calendar).
• If the person uses glasses and/or hearing aids, bring them, as they will feel more secure.
• Patients can lose all sense of time during their hospitalisation. It is very important to help the person feel oriented, know what day it is and the time of day (morning, afternoon, night), where they are and what has happened. 
• Whenever possible, encourage the person to move (small steps) and do basic activities for themselves (e.g. dressing, eating).
• It is a good idea for the person to have some personal objects, such as family photos, a radio with earphones (to avoid disturbing other patients), magazines, books and puzzles. This will help them stay mentally active and occupied. Bear in mind their preferences. 
• Check that there is enough lighting during the day, preferably natural light if the space allows it, and keep the room dark or dimly lit at night. This favours rest at night and activity during the day. If necessary, a small light can be left on, so the person can see where they are and go to the restroom, if they can go alone.
• During the night, when you go and the person is left alone, tell the nurses to leave a small light on, so they know where they are if they wake up. 
• Try to stop the person with delirium from sleeping during the day, with activities such as talking to them, or reading a book, magazine or newspaper to them. The light must be dimmed at night and the television turned off to facilitate sleep.
• As long as there are no contraindications from the care team, encourage the person to eat food and stay hydrated. 
• When you talk, use clear, simple words, and a gentle, soothing tone. Don’t contradict them and explain things to them calmly. 
• You need to understand that the patient is not aware of their actions, so you should not get frustrated or blame them. 
• Do not contradict the patient in cases of delirium or hallucinations. 
• Do not confuse delirium with dementia; they sometimes co-exist, but are not the same thing. 
• As the main carer, you must also care for yourself.
• If you have any doubts, ask the nursing team.