Delirium in the older person
Delirium is a sudden, fluctuating change in mental state, which disturbs thinking and attention, and results in changed behaviour.
If delirium is not recognized, it can lead to permanent disability or death.
This information is for anyone who supports an elder who develops a delirium – family members and health care professionals alike.
A Medical Emergency
Delirium is a change in mental state which comes on suddenly, fluctuates over 24 hours, alters consciousness, disturbs thinking and attention and results in changed behaviour. Symptoms include problems with attention, thinking, memory, psychomotor changes and disruption of the sleep-wake cycle (Lipowski, 1989; Ignatavicious, 1999; Bater, 2006; DSM-5, 2013).
Delirium is considered a “medical emergency”
Delirium affects older persons in all areas of health care. All staff must be skillful in recognizing and responding to it.
The statistics are shocking. Despite the fact that Delirium is treatable,
In Acute Care:
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50% of older persons may develop delirium in hospital
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40-50% of older persons develop delirium after hip surgery
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70% of person 65+ admitted to intensive care (National Guidelines, 2014)
In Residential Care:
- 22-89% of residents with dementia experience delirium (National Guidelines, 2014)
Delirium in the Older Person: A Family Guide
Winner of a 2007 Gold Questar International Award for Video Communication.
Delirium in the Older Person: A Medical Emergency
Winner of the 2006 International Medical Media Award for Geriatrics (The Freddies)
Also Watch:
- Assessment
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- Intervention
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- Acute Care
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- Residential Care
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- Home and Community Care
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- Delirium at End of Life
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Use:
- as a teaching tool to improve ability to recognize, assess and intervene with delirium
- for formal education of staff, families and clients
- to learn about Delirium Watch and Elder Friendly programs in acute care
- for case conferencing and discussion groups
- as self-directed learning, at your convenience and at your own pace
- conjunction with resources from this website
Useful Links
- Canadian Coalition of Seniors Mental Health
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Tools for Seniors and Families, and for Clinicians, including the National Guidelines for Assessment and Treatment of Delirium and more: https://ccsmh.ca/projects/delirium/
- RN Association of Ontario
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Nursing Best Practice Guideline and Caregiving Strategies for Older Adults with Delirium, Dementia and Depression. RNAO - Nursing Best Practices
- HealthLink BC
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Talk to a nurse by phone, or contact them for algorithms for delirium. In British Columbia, dial 8-1-1. http://www.healthlinkbc.ca/
- Acute Care Geriatric Nurse Network
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Delirium Clinical Practice Guidelines; links and resources from BC's Clinical Nurse Specialists in geriatrics, gerontology, geropsychiatry, and geriatric rehabilitation. http://www.acgnn.ca/delirium.html
- Institute for Health Care Improvement
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http://www.ihi.org/topics/SedationDeliriumMobility/Pages/default.aspx
- Delirium in ICU
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http://www.icudelirium.org/
http://www.medpagetoday.com/CriticalCare/GeneralCriticalCare/42029
- National Institute for Health Care Excellence
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http://pathways.nice.org.uk/pathways/delirium#path=view%3A/pathways/delirium/delirium-overview.xml&content=view-index
http://www.nice.org.uk/guidance/QS63/chapter/introduction
Resources
Information about delirium for families and health care professionals, including tools, flow sheets, learning tools and professional practice information.
- About Delirium
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Delirium in the Older Person. Overview of delirium; tools for recognition, assessment and treatment of delirium are placed in context. This is a useful teaching handout. Bibliography.
- Quick Reference Tools
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Delirium Decision Tree
Quick Reference Guide
- Prevention
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Island Health Delirium Clinical Standards Guidelines [Please contact us]
Drugs that can Cause Delirium
You Can Prevent Delirium Poster
- Recognition
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Information Pamphlet for Families
Information Pamphlet for Health Care Providers
2 Ds Differentiating Delirium from Dementia
3 Ds Differentiating Delirium from Dementia and Depression
Physiological Changes with Aging
Age-Related Changes
- Assessment
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Confusion Assessment Method (CAM)
CAM Training Manual
CAM-ICU
CAM-ICU Training manual
Laboratory Investigations
Behaviour Monitoring Chart
Sleep-Wake Monitoring Chart
Sleep Hygiene Log
Symptom Screening
Search for Cause (legal-size)
- Intervention
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Search for Solutions (legal-size)
Hallucinations and Delusions
- Learning about Delirium: Take a Quiz
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Age-Related Changes (read before playing game below)
Jeopardy!
Delirium Crossword
2D Quiz Delirium, Dementia or Depression? - answer key included
3D Quiz Delirium, Dementia or Depression? - answer key included
Pre and Post Learning Test - answer key included
- Professional Practice Resources
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Acute Care
The Assessment and Treatment of Delirium - Canadian Coalition for Seniors’ Mental Health 2014 Guideline Update
Delirium Watch - Alert
For additional tools used within Island Health, see Seniors Health or contact us.
Delirium at End of Life
End of Life Care National Health Service, U.K.
Disclaimer:
The documents available on this Delirium website are designed as a general reference for dealing with delirium in the older person.
The information contained herein was written for use within Island Health and we make no warranty, expressed or implied. While care has been taken to ensure accuracy of the information, it is not intended to provide medical advice or to replace the specific recommendations of physicians and other health team members. Since Best Practice and Standards of Care are constantly evolving, it is advised that this site not be used as the sole source of information. You are encouraged to also consult other current references.
